Healthcare Provider Details

I. General information

NPI: 1689357980
Provider Name (Legal Business Name): E-ROD TRANSPORTATION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2023
Last Update Date: 08/11/2023
Certification Date: 08/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5166 WILDWOOD DR
SORRENTO LA
70778-3430
US

IV. Provider business mailing address

5166 WILDWOOD DR
SORRENTO LA
70778-3430
US

V. Phone/Fax

Practice location:
  • Phone: 504-606-8331
  • Fax:
Mailing address:
  • Phone: 504-606-8331
  • Fax:

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: ELISSAH MARTIN
Title or Position: MANAGER
Credential:
Phone: 504-606-8331