Healthcare Provider Details
I. General information
NPI: 1881460384
Provider Name (Legal Business Name): CUP CHRONICLES TRANSPORTATION SERVICES, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 11/27/2023
Last Update Date: 11/27/2023
Certification Date: 11/27/2023
Deactivation Date:
Reactivation Date:
III. Provider practice location address
2413 DAKOTA CLIFF ST
RUSKIN FL
33570-6389
US
IV. Provider business mailing address
2413 DAKOTA CLIFF ST
RUSKIN FL
33570-6389
US
V. Phone/Fax
- Phone: 727-482-4002
- Fax:
- Phone: 727-482-4002
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 343900000X |
| Taxonomy | Non-emergency Medical Transport (VAN) |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: MRS.
CHARRE
LAING
Title or Position: OWNER
Credential:
Phone: 727-482-4002