Healthcare Provider Details

I. General information

NPI: 1073149910
Provider Name (Legal Business Name): TWO COUSINS TRANSPORTATION LLC,
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2020
Last Update Date: 03/22/2020
Certification Date: 03/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

846 WOODLAND HILLS DR APT 6
PHILADELPHIA MS
39350-3300
US

IV. Provider business mailing address

846 WOODLAND HILLS DR APT 6
PHILADELPHIA MS
39350-3300
US

V. Phone/Fax

Practice location:
  • Phone: 601-416-8675
  • Fax:
Mailing address:
  • Phone: 601-416-8675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code344600000X
TaxonomyTaxi
License Number
License Number State

VIII. Authorized Official

Name: DEJUANA LANGDON
Title or Position: OWNER/OPERATOR
Credential:
Phone: 419-239-4461