Healthcare Provider Details

I. General information

NPI: 1912433863
Provider Name (Legal Business Name): SENIOR CARE TRANSPORTATION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 05/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6801 MERRILL RD
JACKSONVILLE FL
32277-3632
US

IV. Provider business mailing address

6801 MERRILL RD
JACKSONVILLE FL
32277-3632
US

V. Phone/Fax

Practice location:
  • Phone: 866-307-3646
  • Fax: 866-524-4125
Mailing address:
  • Phone: 866-307-3646
  • 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 Code347E00000X
TaxonomyTransportation Broker
License Number
License Number State

VIII. Authorized Official

Name: ARTEUS D SULLIVAN
Title or Position: CO-OWNER
Credential:
Phone: 866-307-3646