Healthcare Provider Details

I. General information

NPI: 1124526991
Provider Name (Legal Business Name): CROSS NON-EMERGENCY MEDICAL TRANSPORTATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2018
Last Update Date: 01/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 WASHINGTON AVE
SANTA FE NM
87501-2073
US

IV. Provider business mailing address

7027 S 58TH AVE
LAVEEN AZ
85339-2266
US

V. Phone/Fax

Practice location:
  • Phone: 480-277-1016
  • Fax:
Mailing address:
  • Phone: 480-277-1016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: FITSUM ABREHA SR.
Title or Position: MANAGER
Credential: OWNER
Phone: 480-277-1016