Healthcare Provider Details

I. General information

NPI: 1700332939
Provider Name (Legal Business Name): ESAH TRANSPORTATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2016
Last Update Date: 08/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 N CHURCH ST STE 105
ROCKFORD IL
61110
US

IV. Provider business mailing address

49 W SLADE ST STE 2
PALATINE IL
60067
US

V. Phone/Fax

Practice location:
  • Phone: 847-489-9000
  • Fax: 815-489-9001
Mailing address:
  • Phone: 847-202-1249
  • Fax: 847-496-5963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number7368MC
License Number StateIL

VIII. Authorized Official

Name: SERGEY YAKOVLEV
Title or Position: PRESIDENT
Credential:
Phone: 847-202-1249