Provider Demographics
NPI:1679278501
Name:ETT TRANSPORTATION LLC
Entity type:Organization
Organization Name:ETT TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/ SHAREHOLDER
Authorized Official - Prefix:
Authorized Official - First Name:EDEN
Authorized Official - Middle Name:DAWIT
Authorized Official - Last Name:SHUMBULO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-668-6121
Mailing Address - Street 1:5465 N MORGAN ST APT 501
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22312-3328
Mailing Address - Country:US
Mailing Address - Phone:571-668-6121
Mailing Address - Fax:571-281-4722
Practice Address - Street 1:5465 N MORGAN ST APT 501
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22312-3328
Practice Address - Country:US
Practice Address - Phone:571-668-6121
Practice Address - Fax:571-281-4722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-31
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)