Healthcare Provider Details

I. General information

NPI: 1023937083
Provider Name (Legal Business Name): GOLDEN EAGLE TRANSPORT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4515 W CAROL AVE
GLENDALE AZ
85302-3707
US

IV. Provider business mailing address

4515 W CAROL AVE
GLENDALE AZ
85302-3707
US

V. Phone/Fax

Practice location:
  • Phone: 623-850-1855
  • Fax:
Mailing address:
  • Phone: 623-850-1855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MRS. JULIA TACHINE JESSEN
Title or Position: OWNER
Credential:
Phone: 623-850-1855