Provider Demographics
NPI:1881071504
Name:KEY AMBULLETTE SERVICE INC.
Entity type:Organization
Organization Name:KEY AMBULLETTE SERVICE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:LALLAVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-783-1020
Mailing Address - Street 1:447 DEKALB AVE
Mailing Address - Street 2:SUITE 3R
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11205-4738
Mailing Address - Country:US
Mailing Address - Phone:718-783-1020
Mailing Address - Fax:929-210-9861
Practice Address - Street 1:447 DEKALB AVE
Practice Address - Street 2:SUITE 3R
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11205-4738
Practice Address - Country:US
Practice Address - Phone:718-783-1020
Practice Address - Fax:929-210-9861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-01
Last Update Date:2015-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY39310343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)