Healthcare Provider Details

I. General information

NPI: 1982396362
Provider Name (Legal Business Name): ECCENTRIC 28 TRANSPORTATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2023
Last Update Date: 05/28/2023
Certification Date: 05/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6101 W 79TH ST
BURBANK IL
60459-1368
US

IV. Provider business mailing address

6101 W 79TH ST
BURBANK IL
60459-1368
US

V. Phone/Fax

Practice location:
  • Phone: 773-407-5900
  • Fax:
Mailing address:
  • Phone: 773-407-5900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code342000000X
TaxonomyTransportation Network Company
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code347B00000X
TaxonomyBus
License Number
License Number State

VIII. Authorized Official

Name: DAJUANA SLATTON
Title or Position: CEO
Credential:
Phone: 773-407-5900