Healthcare Provider Details

I. General information

NPI: 1700607025
Provider Name (Legal Business Name): SBW FAMILY TRANSPORTATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2024
Last Update Date: 10/19/2024
Certification Date: 10/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2017 219TH PL
SAUK VILLAGE IL
60411-5005
US

IV. Provider business mailing address

2017 219TH PL
SAUK VILLAGE IL
60411-5005
US

V. Phone/Fax

Practice location:
  • Phone: 219-281-9245
  • Fax:
Mailing address:
  • Phone: 219-281-9245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: BLAKE WILKINS SR.
Title or Position: MANAGER/OWNER
Credential:
Phone: 219-281-9245