Healthcare Provider Details

I. General information

NPI: 1831727346
Provider Name (Legal Business Name): SELFLESS SERVICE TRANSPORTATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2020
Last Update Date: 03/30/2020
Certification Date: 03/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

523 APPOMATTOX ST
NORFOLK VA
23523-1616
US

IV. Provider business mailing address

523 APPOMATTOX ST
NORFOLK VA
23523-1616
US

V. Phone/Fax

Practice location:
  • Phone: 757-685-5991
  • Fax:
Mailing address:
  • Phone: 757-685-5991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State

VIII. Authorized Official

Name: LEVETTE DENISE NICHOLS
Title or Position: CEO/PRESIDENT
Credential:
Phone: 757-685-5991