Healthcare Provider Details

I. General information

NPI: 1215611587
Provider Name (Legal Business Name): LIFE LINK TRANSPORT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2023
Last Update Date: 06/20/2023
Certification Date: 06/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 AVONWOOD RD APT 317
AVON CT
06001-2017
US

IV. Provider business mailing address

360 BLOOMFIELD AVE STE 301
WINDSOR CT
06095-2700
US

V. Phone/Fax

Practice location:
  • Phone: 778-685-1482
  • Fax:
Mailing address:
  • Phone: 778-685-1482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code344600000X
TaxonomyTaxi
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code342000000X
TaxonomyTransportation Network Company
License Number
License Number StateNULL

VIII. Authorized Official

Name: ABDULKADIR BWANA ABDULKADIR
Title or Position: MANAGING AGENT/OWNER
Credential:
Phone: 778-685-1482