Healthcare Provider Details

I. General information

NPI: 1912748088
Provider Name (Legal Business Name): EXECUTIVE TRANSPORTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2024
Last Update Date: 06/05/2024
Certification Date: 06/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

579 GUTHRIE TURNER RD
SNOW HILL NC
28580-8764
US

IV. Provider business mailing address

579 GUTHRIE TURNER RD
SNOW HILL NC
28580-8764
US

V. Phone/Fax

Practice location:
  • Phone: 252-607-0498
  • Fax:
Mailing address:
  • Phone: 252-607-0498
  • Fax: 252-486-8715

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: SHEILA DANIELS
Title or Position: DIRECTOR
Credential:
Phone: 252-607-0498