=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114721776
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PARADISE TRANSPORTATION SERVICE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/02/2025
-----------------------------------------------------
Last Update Date | 04/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8750 W MILL RD APT 1
-----------------------------------------------------
City | MILWAUKEE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53225-1849
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-283-3023
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8750 W MILL RD APT 1
-----------------------------------------------------
City | MILWAUKEE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53225-1849
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-283-3023
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MS. MONISHA WILSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 414-943-8824
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------