Healthcare Provider Details

I. General information

NPI: 1619753365
Provider Name (Legal Business Name): UNIVERSAL ITECH TRANSPORTAION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2023
Last Update Date: 09/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11166 FAIRFAX BLVD SUITE 500 #1040
FAIRFAX VA
22030
US

IV. Provider business mailing address

8113 HICKORY HOLLOW DR.
GLEN BURNIE MD
21060
US

V. Phone/Fax

Practice location:
  • Phone: 703-930-2298
  • Fax:
Mailing address:
  • Phone: 703-930-2298
  • Fax:

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 Code344600000X
TaxonomyTaxi
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code347B00000X
TaxonomyBus
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: TARILA JAMES AMAJENE
Title or Position: MANAGER
Credential:
Phone: 202-379-8876