Healthcare Provider Details

I. General information

NPI: 1134632425
Provider Name (Legal Business Name): PERSEVERANCE EXCELLENCE COURAGE COMMUNITY MEDICAL TRAN.SERVICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2017
Last Update Date: 11/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3836 CHINKAPIN ST
HARVEY LA
70058-2021
US

IV. Provider business mailing address

3836 CHINKAPIN ST
HARVEY LA
70058-2021
US

V. Phone/Fax

Practice location:
  • Phone: 504-684-9050
  • Fax: 504-348-3967
Mailing address:
  • Phone: 504-684-9050
  • Fax: 504-348-3967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SHANIKA GENISE SLY
Title or Position: OWNER
Credential:
Phone: 504-684-9050