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General NPI Number Information
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NPI Number | 1083927370
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Entity Type | Organization
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Legal Business Name | FATHER ABRAHAM TRANSPORT INC
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Dates
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Enumeration Date | 07/15/2010
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Last Update Date | 07/15/2010
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Provider Practice Location Address
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Address Line | 25370 GLENBROOK BLVD
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City | EUCLID
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State | OH
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Zip | 44117-1818
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Country | US
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Telephone | 216-235-4425
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Fax |
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Provider Business Mailing Address
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Address Line | 25370 GLENBROOK BLVD
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City | EUCLID
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State | OH
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Zip | 44117-1818
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Country | US
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Telephone | 216-235-4425
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | REGINALD E. MACK
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Credential |
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Telephone | 216-235-4425
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number | S761924
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License Number State | OH
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