Healthcare Provider Details

I. General information

NPI: 1962854778
Provider Name (Legal Business Name): TOTAL TRANSPORTATION 1, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2016
Last Update Date: 07/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24130 TELEGRAPH RD
SOUTHFIELD MI
48033-3020
US

IV. Provider business mailing address

24130 TELEGRAPH RD
SOUTHFIELD MI
48033-3020
US

V. Phone/Fax

Practice location:
  • Phone: 248-469-4673
  • Fax: 248-282-8709
Mailing address:
  • Phone: 248-469-4673
  • Fax: 248-282-8709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CHIRINE GHANDOUR
Title or Position: PRESIDENT
Credential:
Phone: 248-469-4673