Healthcare Provider Details

I. General information

NPI: 1730043738
Provider Name (Legal Business Name): SOUTHLAND TRANSPORTATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2025
Last Update Date: 12/13/2025
Certification Date: 12/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11623 S LONGWOOD DR
CHICAGO IL
60643-4829
US

IV. Provider business mailing address

5469 EDISON AVE
OAK LAWN IL
60453-2943
US

V. Phone/Fax

Practice location:
  • Phone: 708-502-8190
  • Fax:
Mailing address:
  • Phone: 708-502-8190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State

VIII. Authorized Official

Name: MR. MYLAN LEO SANDERS
Title or Position: OWNER
Credential:
Phone: 708-502-8190