MEDICARE: A RAE OF LIGHT 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)

General Provider Information

NPI Number	:	1265197024
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A RAE OF LIGHT TRANSPORTATION, LLC

Provider Business Mailing Address
First Line	:	PO BOX 2680
Second Line	:
City	:	GRETNA
State	:	LA
Zip	:	70054-2680
Country	:	US
Telephone Number	:	504-319-4565
Fax Number	:

Provider Business Practice Location Address
First Line	:	3817 BUCHANAN ST
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70122-1106
Country	:	US
Telephone Number	:	504-319-4656
Fax Number	:	504-319-4565

Authorized Official
Title or Position	:	OWNER
Name	:	MS. RENEE A DALTON
Credential	:
Telephone Number	:	504-319-4565

Provider Enumeration Date	:	11/05/2021
Last Update Date	:	11/05/2021

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