MEDICARE: ENRICH MOBILITY 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	347E00000X	Transportation Broker
2	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1770145062
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENRICH MOBILITY SERVICES LLC

Provider Business Mailing Address
First Line	:	3201 CENTURY PARK BLVD APT 422
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78727-1219
Country	:	US
Telephone Number	:	512-524-9801
Fax Number	:

Provider Business Practice Location Address
First Line	:	3201 CENTURY PARK BLVD APT 422
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78727-1219
Country	:	US
Telephone Number	:	512-524-9801
Fax Number	:

Authorized Official
Title or Position	:	OWNER/OPERATOR
Name	:	MS. CANDACE FELISA MORGAN
Credential	:
Telephone Number	:	512-524-9801

Provider Enumeration Date	:	07/08/2019
Last Update Date	:	07/08/2019

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