Healthcare Provider Details

I. General information

NPI: 1205321874
Provider Name (Legal Business Name): PENTAGON RIDES & TRANSPORT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2018
Last Update Date: 06/08/2023
Certification Date: 06/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

719 NILES ST. STE E-1
BAKERSFIELD CA
93305-4400
US

IV. Provider business mailing address

24167 CRUISE CIRCLE DR.
CANYON LAKE CA
92587-7735
US

V. Phone/Fax

Practice location:
  • Phone: 951-244-9413
  • Fax: 951-552-1195
Mailing address:
  • Phone: 951-241-9431
  • Fax: 951-552-1195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number State

VIII. Authorized Official

Name: MR. SCOTT K WEST JR.
Title or Position: CEO
Credential:
Phone: 951-990-3444