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General NPI Number Information
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NPI Number | 1184088759
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Entity Type | Organization
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Legal Business Name | GENESIS III TRANSPORTATION LLC
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Dates
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Enumeration Date | 04/11/2016
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Last Update Date | 04/11/2016
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Provider Practice Location Address
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Address Line | 64 W 154TH ST
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City | SOUTH HOLLAND
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State | IL
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Zip | 60473-1076
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Country | US
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Telephone | 708-937-8339
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Fax | 708-566-5312
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Provider Business Mailing Address
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Address Line | 64 W 154TH ST
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City | SOUTH HOLLAND
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State | IL
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Zip | 60473-1076
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Country | US
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Telephone | 708-937-8339
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Fax | 708-566-5312
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Authorized Official
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Title or Position | PRESIDENT, CEO
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Name | TANIA M THOMPSON
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Credential |
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Telephone | 708-937-8339
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number | T51281384710
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number | T51281384710
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License Number State | IL
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