Healthcare Provider Details

I. General information

NPI: 1205347929
Provider Name (Legal Business Name): EXQUISITE TRANSPORTATION SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2017
Last Update Date: 10/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3004 VERNON AVE S
LEHIGH ACRES FL
33973-6152
US

IV. Provider business mailing address

3004 VERNON AVE S
LEHIGH ACRES FL
33973-6152
US

V. Phone/Fax

Practice location:
  • Phone: 239-895-7792
  • Fax:
Mailing address:
  • Phone: 239-895-7792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code344600000X
TaxonomyTaxi
License NumberL17000215200
License Number StateFL

VIII. Authorized Official

Name: MR. ELISHA LEARDER JONES
Title or Position: MANAGER
Credential:
Phone: 239-895-7792