Healthcare Provider Details

I. General information

NPI: 1992684054
Provider Name (Legal Business Name): MG HEALING WHEELS TRANSPORTATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 MUROC LAKE DR APT 615
NOVATO CA
94949-4509
US

IV. Provider business mailing address

490 POST ST STE 500
SAN FRANCISCO CA
94102-1406
US

V. Phone/Fax

Practice location:
  • Phone: 415-368-8201
  • Fax:
Mailing address:
  • Phone: 504-334-0901
  • 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: MONIQUE SHURICE JOHNSON
Title or Position: CEO
Credential:
Phone: 415-368-8201