Healthcare Provider Details

I. General information

NPI: 1669847554
Provider Name (Legal Business Name): GREATER LIVING TRANSPORTATION LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2015
Last Update Date: 12/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5617 BEVERLEY RD
BROOKLYN NY
11203-5407
US

IV. Provider business mailing address

5617 BEVERLEY RD
BROOKLYN NY
11203-5407
US

V. Phone/Fax

Practice location:
  • Phone: 718-451-9700
  • Fax: 718-451-9800
Mailing address:
  • Phone: 718-451-9700
  • Fax: 718-451-9800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number39275
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code344600000X
TaxonomyTaxi
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: MR. RICHARD MILLER
Title or Position: MANAGING MEMBER
Credential: CCS, CPC
Phone: 718-451-9700