Healthcare Provider Details

I. General information

NPI: 1902177686
Provider Name (Legal Business Name): ASSISTED LIVING LOCATORS - TRANSPORTATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2012
Last Update Date: 01/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5760 S ELAND DR
FORT MOHAVE AZ
86426-9293
US

IV. Provider business mailing address

PO BOX 8625
FORT MOHAVE AZ
86427-8625
US

V. Phone/Fax

Practice location:
  • Phone: 928-533-7221
  • Fax: 888-503-3633
Mailing address:
  • Phone: 928-533-7221
  • Fax: 888-503-3633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License Number343800000X
License Number StateAZ

VIII. Authorized Official

Name: MR. JIMMY GILBERT
Title or Position: OWNER
Credential:
Phone: 928-533-7221