Healthcare Provider Details

I. General information

NPI: 1275240459
Provider Name (Legal Business Name): GREENLIGHT MEDICAL TRANSPORTATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2022
Last Update Date: 10/28/2022
Certification Date: 10/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6227 CRESTWAY AVE
BATON ROUGE LA
70812-1531
US

IV. Provider business mailing address

6227 CRESTWAY AVE
BATON ROUGE LA
70812-1531
US

V. Phone/Fax

Practice location:
  • Phone: 225-229-5906
  • Fax:
Mailing address:
  • Phone: 225-229-5906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code342000000X
TaxonomyTransportation Network Company
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: JHADE R GREENE
Title or Position: OWNER/OPERATOR
Credential:
Phone: 225-229-5906