Healthcare Provider Details

I. General information

NPI: 1669365433
Provider Name (Legal Business Name): RUSSELL'S TRANSPORTATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2025
Last Update Date: 06/17/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3807 MERRYMOUND RD
SOUTH EUCLID OH
44121-1907
US

IV. Provider business mailing address

25000 EUCLID AVE STE 108 #524
EUCLID OH
44117-2621
US

V. Phone/Fax

Practice location:
  • Phone: 216-262-8389
  • Fax:
Mailing address:
  • Phone: 216-619-6972
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: MRS. ERICA RUSSELL
Title or Position: OWNER
Credential:
Phone: 216-262-8389