=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134580434
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GOSHEN TRANSPORTATION SERVICE/ELOHIMS CONNECTIONS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/14/2016
-----------------------------------------------------
Last Update Date | 03/14/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 19200 MONTEREY AVE
-----------------------------------------------------
City | EUCLID
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44119-1614
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-336-3057
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | P.O. BOX 19334
-----------------------------------------------------
City | EUCLID
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44119-1614
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-336-3057
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | NON-EMERGENCY TRANSPORT
-----------------------------------------------------
Name | MS. SANDRA JOHNSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 216-336-3057
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------