MEDICARE: T&RHEART, 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	:	1407468481
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	T&RHEART, LLC

Provider Business Mailing Address
First Line	:	869 LYNNHAVEN RD STE 113
Second Line	:	BOX 182
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23452
Country	:	US
Telephone Number	:	757-418-5029
Fax Number	:

Provider Business Practice Location Address
First Line	:	3245 GREEN LAKES DR
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23452-4914
Country	:	US
Telephone Number	:	757-418-5029
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DACHENIQUA HEART
Credential	:
Telephone Number	:	757-418-5029

Provider Enumeration Date	:	08/20/2020
Last Update Date	:	08/20/2020

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