Healthcare Provider Details

I. General information

NPI: 1144945577
Provider Name (Legal Business Name): HOME BASE TRANSPORTATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2022
Last Update Date: 10/07/2022
Certification Date: 10/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

617 N EBRITE ST
MESQUITE TX
75149-3453
US

IV. Provider business mailing address

617 N EBRITE ST
MESQUITE TX
75149-3453
US

V. Phone/Fax

Practice location:
  • Phone: 972-571-9273
  • Fax:
Mailing address:
  • Phone: 972-571-9273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MIKE GIBSON
Title or Position: OWNER
Credential:
Phone: 972-571-9273