Healthcare Provider Details

I. General information

NPI: 1396106779
Provider Name (Legal Business Name): GORE SAFE TRANSPORTATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2016
Last Update Date: 09/24/2020
Certification Date: 09/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6110 POWERS AVE SUITE 11
JACKSONVILLE FL
32217-1206
US

IV. Provider business mailing address

6110 POWERS AVE SUITE 11
JACKSONVILLE FL
32217-1206
US

V. Phone/Fax

Practice location:
  • Phone: 904-859-8859
  • Fax: 904-508-0236
Mailing address:
  • Phone: 904-859-8859
  • Fax: 904-508-0236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code344600000X
TaxonomyTaxi
License NumberL-2465
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateFL

VIII. Authorized Official

Name: NADA CHEHAB
Title or Position: MGR
Credential:
Phone: 904-508-0233