Healthcare Provider Details

I. General information

NPI: 1689543647
Provider Name (Legal Business Name): NAN TRANSPORTATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2025
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 PENNSYLVANIA AVE
SANFORD NC
27332-7363
US

IV. Provider business mailing address

1400 PENNSYLVANIA AVE
SANFORD NC
27332-7363
US

V. Phone/Fax

Practice location:
  • Phone: 804-912-5578
  • Fax:
Mailing address:
  • Phone: 804-912-5578
  • 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 Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: DR. KALKIDAN SHIMELIS DESTA
Title or Position: OWNER
Credential: DR.
Phone: 804-912-5578