Provider Demographics
NPI:1801980552
Name:TLC SPECIAL TRANSPORTATION, INC.
Entity type:Organization
Organization Name:TLC SPECIAL TRANSPORTATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BORIS
Authorized Official - Middle Name:
Authorized Official - Last Name:AVERBAKH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-882-0535
Mailing Address - Street 1:900 W 128TH STREET
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337
Mailing Address - Country:US
Mailing Address - Phone:952-882-0535
Mailing Address - Fax:952-882-0571
Practice Address - Street 1:900 W 128TH STREET
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337
Practice Address - Country:US
Practice Address - Phone:952-882-0535
Practice Address - Fax:952-882-0571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNSTS153668343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)