Healthcare Provider Details

I. General information

NPI: 1124982996
Provider Name (Legal Business Name): CERTIFIED CARE TRANSPORTATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 BRYCE CT
APTOS CA
95003-4729
US

IV. Provider business mailing address

125 BRYCE CT
APTOS CA
95003-4729
US

V. Phone/Fax

Practice location:
  • Phone: 831-287-4765
  • Fax:
Mailing address:
  • Phone: 831-287-4765
  • 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: MR. ALEXANDER FORTUN
Title or Position: CO-OWNER
Credential:
Phone: 919-239-1038