MEDICARE: GREATHOUSE MEDICAL TRANSPORTATION 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)	RU784914	OH

General Provider Information

NPI Number	:	1225128507
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREATHOUSE MEDICAL TRANSPORTATION LLC

Provider Business Mailing Address
First Line	:	3937 ELMWOOD RD
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44121-2432
Country	:	US
Telephone Number	:	216-383-8826
Fax Number	:	216-382-8831

Provider Business Practice Location Address
First Line	:	3937 ELMWOOD RD
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44121-2432
Country	:	US
Telephone Number	:	216-383-8826
Fax Number	:	216-382-8831

Authorized Official
Title or Position	:	OWNER/DRIVER
Name	:	CHRISTINE GREATHOUSE
Credential	:
Telephone Number	:	216-383-8826

Provider Enumeration Date	:	10/15/2006
Last Update Date	:	08/22/2020

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