MEDICARE: ELNORAS SENIOR TRANSIT LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1073391504
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELNORAS SENIOR TRANSIT LLC

Provider Business Mailing Address
First Line	:	207 LACKELL AVE UNIT 10
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78226-1617
Country	:	US
Telephone Number	:	210-793-2024
Fax Number	:

Provider Business Practice Location Address
First Line	:	207 LACKELL AVE UNIT 10
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78226-1617
Country	:	US
Telephone Number	:	210-793-2024
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DENISE A QUALLS
Credential	:
Telephone Number	:	210-793-2024

Provider Enumeration Date	:	09/18/2023
Last Update Date	:	09/18/2023

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Directions to “ELNORAS SENIOR TRANSIT LLC ” Practice Location

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