Healthcare Provider Details

I. General information

NPI: 1154831253
Provider Name (Legal Business Name): LAS ENTERPRISES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2017
Last Update Date: 10/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 SAINT ANNES CT
AURORA IL
60504-2021
US

IV. Provider business mailing address

3500 SAINT ANNES CT
AURORA IL
60504-2021
US

V. Phone/Fax

Practice location:
  • Phone: 331-212-6155
  • Fax: 331-212-6155
Mailing address:
  • Phone: 331-212-6155
  • Fax: 331-212-6155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. LATANIA SAMMAY PARKES
Title or Position: DIRECTOR
Credential: RN
Phone: 331-212-6155