Healthcare Provider Details

I. General information

NPI: 1982396933
Provider Name (Legal Business Name): TEN DOLLAH HOLLA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2023
Last Update Date: 05/25/2023
Certification Date: 05/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

437 W MYRTLE AVE
YOUNGSTOWN OH
44511-1625
US

IV. Provider business mailing address

437 W MYRTLE AVE
YOUNGSTOWN OH
44511-1625
US

V. Phone/Fax

Practice location:
  • Phone: 330-301-0556
  • Fax:
Mailing address:
  • Phone: 330-301-0556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code342000000X
TaxonomyTransportation Network Company
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: NATASHA SIMON
Title or Position: ADMINISTATOR
Credential: RN
Phone: 330-301-0556