Healthcare Provider Details

I. General information

NPI: 1124936984
Provider Name (Legal Business Name): CANYON CARE TRANSPORTATION LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 E MICHIGAN AVE
PHOENIX AZ
85022-1223
US

IV. Provider business mailing address

1201 E MICHIGAN AVE
PHOENIX AZ
85022-1223
US

V. Phone/Fax

Practice location:
  • Phone: 615-738-1397
  • Fax:
Mailing address:
  • Phone: 615-738-1397
  • 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: TIBA IMAD LATEEF
Title or Position: OWNER
Credential:
Phone: 615-738-1397