Healthcare Provider Details

I. General information

NPI: 1659194942
Provider Name (Legal Business Name): EDUCATIONAL TRANSPORT COLLABORATIVE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2024
Last Update Date: 11/13/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68 DRINKWATER RD
EXETER NH
03833-4600
US

IV. Provider business mailing address

68 DRINKWATER RD
EXETER NH
03833-4600
US

V. Phone/Fax

Practice location:
  • Phone: 603-748-1340
  • Fax:
Mailing address:
  • Phone: 603-748-1340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number State

VIII. Authorized Official

Name: MRS. JANINE LELAND RICHARDS
Title or Position: MANAGING MEMBER
Credential: LICSW
Phone: 603-748-1340