Healthcare Provider Details

I. General information

NPI: 1235961426
Provider Name (Legal Business Name): EBEN-EZER DELIVERY & TRANSPORTATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

134 FLUSHING AVE
FAIRFIELD CT
06825-1450
US

IV. Provider business mailing address

134 FLUSHING AVE
FAIRFIELD CT
06825-1450
US

V. Phone/Fax

Practice location:
  • Phone: 901-799-0035
  • Fax:
Mailing address:
  • Phone: 901-799-0035
  • Fax:

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 Code344600000X
TaxonomyTaxi
License Number
License Number State

VIII. Authorized Official

Name: MRS. ARALUZ LARA PINALES
Title or Position: OWNER
Credential:
Phone: 901-799-0035