MEDICARE: GENERATIONAL CARE TRANSPORTATION SERVICES 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	342000000X	Transportation Network Company

General Provider Information

NPI Number	:	1396432241
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENERATIONAL CARE TRANSPORTATION SERVICES LLC

Provider Business Mailing Address
First Line	:	4035 N 70TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53216-1128
Country	:	US
Telephone Number	:	414-388-0903
Fax Number	:

Provider Business Practice Location Address
First Line	:	4035 N 70TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53216-1128
Country	:	US
Telephone Number	:	414-388-0903
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	LT AUSTIN JR.
Credential	:
Telephone Number	:	414-388-0903

Provider Enumeration Date	:	04/20/2023
Last Update Date	:	04/22/2023

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