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General NPI Number Information
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NPI Number | 1023780939
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Entity Type | Individual
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Provider Name | EBONE PORCH
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Gender | Female
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Dates
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Enumeration Date | 09/29/2021
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Last Update Date | 10/05/2021
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Provider Practice Location Address
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Address Line | 1953 W MAYPOLE AVE
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City | CHICAGO
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State | IL
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Zip | 60612-2466
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Country | US
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Telephone | 773-620-0434
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Fax |
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Provider Business Mailing Address
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Address Line | 1953 W MAYPOLE AVE
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City | CHICAGO
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State | IL
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Zip | 60612-2466
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Country | US
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Telephone | 773-620-0434
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 342000000X
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Taxonomy Name | Transportation Network Company
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 343800000X
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Taxonomy Name | Secured Medical Transport (VAN)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 347E00000X
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Taxonomy Name | Transportation Broker
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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