Healthcare Provider Details

I. General information

NPI: 1194557462
Provider Name (Legal Business Name): EXCEPTIONAL CARE TRANSPORTATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2024
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4786 S ELK WAY
AURORA CO
80016-5829
US

IV. Provider business mailing address

4786 S ELK WAY
AURORA CO
80016-5829
US

V. Phone/Fax

Practice location:
  • Phone: 619-309-5572
  • Fax:
Mailing address:
  • Phone: 619-309-5572
  • 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: EDEN HAGOS
Title or Position: EXECUTIVE MANAGER
Credential:
Phone: 720-795-6152