Healthcare Provider Details

I. General information

NPI: 1730002023
Provider Name (Legal Business Name): LAKE WALES TRANSIT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3370 ALEXANDER DR
LAKE WALES FL
33853-4326
US

IV. Provider business mailing address

3370 ALEXANDER DR
LAKE WALES FL
33853-4326
US

V. Phone/Fax

Practice location:
  • Phone: 845-518-1602
  • Fax:
Mailing address:
  • Phone: 845-518-1602
  • 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: KENIEL LEE
Title or Position: OWNER
Credential:
Phone: 845-518-1602