Healthcare Provider Details

I. General information

NPI: 1336603398
Provider Name (Legal Business Name): GO SENIOR TRANSIT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2019
Last Update Date: 01/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

257 S CYPRESS RD APT 418
POMPANO BEACH FL
330607032
US

IV. Provider business mailing address

257 S CYPRESS RD APT 418
POMPANO BEACH FL
330607032
US

V. Phone/Fax

Practice location:
  • Phone: 561-305-1567
  • Fax:
Mailing address:
  • Phone: 561-305-1567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: VENEL SIMON
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 561-305-1567