Provider Demographics
NPI:1447822796
Name:GREEN LIGHT TRANSIT
Entity type:Organization
Organization Name:GREEN LIGHT TRANSIT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RIANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:RIDEAUX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-764-2088
Mailing Address - Street 1:4845 LAKE ST # 138
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-6009
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6859 TOM HEBERT ROAD
Practice Address - Street 2:LOT 377
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70607
Practice Address - Country:US
Practice Address - Phone:337-764-2088
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-15
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)