Healthcare Provider Details

I. General information

NPI: 1295660272
Provider Name (Legal Business Name): PENINSULA CARE SHUTTLE TRANSPORT SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15578 CARROLLTON BLVD
CARROLLTON VA
23314-2308
US

IV. Provider business mailing address

13176 JEFFERSON AVE STE D
NEWPORT NEWS VA
23608-1322
US

V. Phone/Fax

Practice location:
  • Phone: 757-633-5375
  • Fax:
Mailing address:
  • Phone: 757-633-5375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State

VIII. Authorized Official

Name: PENNY MASON
Title or Position: OWNER
Credential:
Phone: 757-633-5375