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General NPI Number Information
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NPI Number | 1215611587
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Entity Type | Organization
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Legal Business Name | LIFE LINK TRANSPORT LLC
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Dates
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Enumeration Date | 06/14/2023
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Last Update Date | 06/20/2023
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Provider Practice Location Address
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Address Line | 47 AVONWOOD RD APT 317
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City | AVON
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State | CT
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Zip | 06001-2017
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Country | US
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Telephone | 778-685-1482
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Fax |
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Provider Business Mailing Address
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Address Line | 360 BLOOMFIELD AVE STE 301
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City | WINDSOR
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State | CT
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Zip | 06095-2700
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Country | US
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Telephone | 778-685-1482
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Fax |
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Authorized Official
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Title or Position | MANAGING AGENT/OWNER
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Name | ABDULKADIR BWANA ABDULKADIR
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Credential |
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Telephone | 778-685-1482
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 342000000X
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Taxonomy Name | Transportation Network Company
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 344600000X
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Taxonomy Name | Taxi
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 347E00000X
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Taxonomy Name | Transportation Broker
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License Number |
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License Number State |
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Taxonomy #4
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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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