Healthcare Provider Details

I. General information

NPI: 1558191395
Provider Name (Legal Business Name): RUACH TRANSPORTATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2024
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16916 SUNSET RIDGE DR
COUNTRY CLUB HILLS IL
60478-2154
US

IV. Provider business mailing address

16916 SUNSET RIDGE DR
COUNTRY CLUB HILLS IL
60478-2154
US

V. Phone/Fax

Practice location:
  • Phone: 708-864-0254
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: TIARA JAKES
Title or Position: CEO/ OWNER/OPERATOR
Credential:
Phone: 708-864-0254