MEDICARE: ELDERLY CARE 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	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1992586960
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELDERLY CARE TRANSPORTATION, LLC

Provider Business Mailing Address
First Line	:	3550 APPLE ORCHARD DR
Second Line	:
City	:	DELTONA
State	:	FL
Zip	:	32738-9403
Country	:	US
Telephone Number	:	386-675-3404
Fax Number	:

Provider Business Practice Location Address
First Line	:	3550 APPLE ORCHARD DR
Second Line	:
City	:	DELTONA
State	:	FL
Zip	:	32738-9403
Country	:	US
Telephone Number	:	386-675-3404
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	GUERLINE GLEZIL
Credential	:
Telephone Number	:	386-675-3404

Provider Enumeration Date	:	10/06/2023
Last Update Date	:	10/12/2023

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