=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043029697
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LUXURY LOGISTICS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/07/2025
-----------------------------------------------------
Last Update Date | 01/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5645 N 86TH PL
-----------------------------------------------------
City | MILWAUKEE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53225-2804
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-915-2015
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5645 N 86TH PL
-----------------------------------------------------
City | MILWAUKEE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53225-2804
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-915-2015
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MS. SHAKITA TIERRA NELSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 414-915-2015
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------