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General NPI Number Information
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NPI Number | 1215522107
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Entity Type | Organization
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Legal Business Name | SENIOR PARADISE TRANSPORTATION
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Dates
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Enumeration Date | 03/03/2021
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Last Update Date | 03/03/2021
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Provider Practice Location Address
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Address Line | 3650 SW VICEROY ST
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City | PORT ST LUCIE
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State | FL
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Zip | 34953-3733
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Country | US
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Telephone | 772-333-0654
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Fax |
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Provider Business Mailing Address
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Address Line | 757 SW SARAZEN AVE
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City | PORT ST LUCIE
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State | FL
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Zip | 34953-3762
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Country | US
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Telephone | 954-812-5105
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Fax |
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Authorized Official
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Title or Position | DRIVER
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Name | PETER DARCY SCOTT
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Credential |
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Telephone | 772-333-0654
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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 |
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License Number State |
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