| Organization Name: | GENESIS III TRANSPORTATION LLC |
| NPI Number: | 1184088759 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | TANIA M THOMPSON (PRESIDENT, CEO) |
| Mailing Address: | 64 W 154th St South Holland |
| State: | IL US |
| Postal Code: | 604731076 |
| Phone Number: | 7089378339 |
| Fax Number: | 7085665312 |
| NPI Enumeration Date: | 04/11/2016 |
| NPI Last Update Date: | 04/11/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 347C00000X |
| License Number: | T51281384710 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | IL |
| Taxonomy Type: | Transportation Services |
| Taxonomy Classification: | Private Vehicle |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual paid to provide non-emergency transportation using their privately owned/leased vehicle. |