Healthcare Provider Details

I. General information

NPI: 1750977393
Provider Name (Legal Business Name): AMERICAN CHARIOT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2020
Last Update Date: 12/17/2020
Certification Date: 12/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 W WHISPERING OAKS LN
ROUND LAKE IL
60073-5004
US

IV. Provider business mailing address

75 COMMERCE DR UNIT 7141
GRAYSLAKE IL
60030-7707
US

V. Phone/Fax

Practice location:
  • Phone: 224-322-8164
  • Fax:
Mailing address:
  • Phone: 224-322-8164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code347B00000X
TaxonomyBus
License Number
License Number State

VIII. Authorized Official

Name: MR. MICAH MOORE
Title or Position: MANAGING MEMBER
Credential:
Phone: 224-322-8164