Healthcare Provider Details

I. General information

NPI: 1619235785
Provider Name (Legal Business Name): BROTHER 2 BROTHER NON EMERGENCY TRANSPORTATION LIMO SERVICE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2012
Last Update Date: 04/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 DAYNA DR
COLLEGE PARK GA
30349-6785
US

IV. Provider business mailing address

805 DAYNA DR
COLLEGE PARK GA
30349-6785
US

V. Phone/Fax

Practice location:
  • Phone: 678-608-6651
  • Fax:
Mailing address:
  • Phone: 678-608-6651
  • Fax: 206-666-6398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number004084987
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: MR. KELVIN L MILNER
Title or Position: MANAGER
Credential:
Phone: 678-608-6651