Healthcare Provider Details

I. General information

NPI: 1821562463
Provider Name (Legal Business Name): MISSION DRIVEN TRANSPORTATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2019
Last Update Date: 01/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18020 MICHAEL AVE
COUNTRY CLUB HILLS IL
60478-5022
US

IV. Provider business mailing address

18020 MICHAEL AVE
COUNTRY CLUB HILLS IL
60478-5022
US

V. Phone/Fax

Practice location:
  • Phone: 630-465-5704
  • Fax:
Mailing address:
  • Phone: 630-465-5704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code344600000X
TaxonomyTaxi
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code347B00000X
TaxonomyBus
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number State

VIII. Authorized Official

Name: MARIE JOHNSON-REYNOLDS
Title or Position: DIRECTOR
Credential:
Phone: 708-362-8960