MEDICARE: SHADES OF SERVICE 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	347E00000X	Transportation Broker

General Provider Information

NPI Number	:	1972448785
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHADES OF SERVICE TRANSPORTATION LLC

Provider Business Mailing Address
First Line	:	1140 E KACHINA TRL
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85042-0033
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1140 E KACHINA TRL
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85042-0033
Country	:	US
Telephone Number	:	480-388-1685
Fax Number	:	480-388-1685

Authorized Official
Title or Position	:	OWNER
Name	:	MS. CHARELL GOLDEN
Credential	:
Telephone Number	:	480-388-1685

Provider Enumeration Date	:	04/20/2026
Last Update Date	:	04/20/2026

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