Healthcare Provider Details

I. General information

NPI: 1770101925
Provider Name (Legal Business Name): PERSONAL CARE TRANSPORTATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2020
Last Update Date: 07/13/2020
Certification Date: 07/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 N EUCLID AVE
UPLAND CA
91786-6038
US

IV. Provider business mailing address

PO BOX 463
UPLAND CA
91785-0463
US

V. Phone/Fax

Practice location:
  • Phone: 909-267-5740
  • Fax:
Mailing address:
  • Phone: 909-267-5740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. LAWRENCE WILSON JR.
Title or Position: OWNER
Credential:
Phone: 909-267-5740