Healthcare Provider Details

I. General information

NPI: 1972448785
Provider Name (Legal Business Name): SHADES OF SERVICE TRANSPORTATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 E KACHINA TRL
PHOENIX AZ
85042-0033
US

IV. Provider business mailing address

1140 E KACHINA TRL
PHOENIX AZ
85042-0033
US

V. Phone/Fax

Practice location:
  • Phone: 480-388-1685
  • Fax: 480-388-1685
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number State

VIII. Authorized Official

Name: MS. CHARELL GOLDEN
Title or Position: OWNER
Credential:
Phone: 480-388-1685