Healthcare Provider Details

I. General information

NPI: 1881361392
Provider Name (Legal Business Name): LIGHTYEAR COMMUTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2021
Last Update Date: 08/24/2021
Certification Date: 08/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11300 IRON BRIDGE RD STE D
CHESTER VA
23831-1428
US

IV. Provider business mailing address

PO BOX 1613
CHESTERFIELD VA
23832-9125
US

V. Phone/Fax

Practice location:
  • Phone: 804-256-8533
  • Fax: 804-362-9003
Mailing address:
  • Phone: 804-256-8533
  • Fax: 804-362-9003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CARA MELLANSON
Title or Position: OWNER
Credential: QMHP
Phone: 804-256-8533