Provider Demographics
NPI:1447712500
Name:L.I.S. TRANSPORTATION LLC
Entity type:Organization
Organization Name:L.I.S. TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:GRETCHEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:SILVA-GLENN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-399-1016
Mailing Address - Street 1:15010 LISA DR
Mailing Address - Street 2:
Mailing Address - City:MAPLE HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44137-4168
Mailing Address - Country:US
Mailing Address - Phone:216-399-1016
Mailing Address - Fax:216-713-0205
Practice Address - Street 1:15010 LISA DR
Practice Address - Street 2:
Practice Address - City:MAPLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44137-4168
Practice Address - Country:US
Practice Address - Phone:216-399-1016
Practice Address - Fax:216-713-0205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-05
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No343800000XTransportation ServicesSecured Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0341070Medicaid