Healthcare Provider Details

I. General information

NPI: 1710618343
Provider Name (Legal Business Name): AWAKE TRANSIT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2022
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

813 HILLTOP DR.
DEFOREST WI
53532
US

IV. Provider business mailing address

813 HILLTOP DR.
DEFOREST WI
53532
US

V. Phone/Fax

Practice location:
  • Phone: 608-628-6220
  • Fax:
Mailing address:
  • Phone: 608-628-6220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: JOHNNY VANG
Title or Position: MANAGING MANAGER
Credential:
Phone: 608-628-6220