MEDICARE: CARE CONNECTION TRANSPORT INC

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	:	1619320413
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARE CONNECTION TRANSPORT INC

Provider Business Mailing Address
First Line	:	1754 TECHNOLOGY DR
Second Line	:	SUITE 120-E
City	:	SAN JOSE
State	:	CA
Zip	:	95110-1308
Country	:	US
Telephone Number	:	408-637-6460
Fax Number	:

Provider Business Practice Location Address
First Line	:	1754 TECHNOLOGY DR
Second Line	:	SUITE 120-E
City	:	SAN JOSE
State	:	CA
Zip	:	95110-1308
Country	:	US
Telephone Number	:	408-637-6460
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MYLAH SPEARS
Credential	:
Telephone Number	:	408-637-6460

Provider Enumeration Date	:	07/15/2016
Last Update Date	:	07/15/2016

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