Healthcare Provider Details

I. General information

NPI: 1699071654
Provider Name (Legal Business Name): ASSISTED LIVING LOCATORS-TRANSPORTATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2011
Last Update Date: 02/08/2011
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 TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number20634211
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number20634211
License Number StateAZ

VIII. Authorized Official

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