=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245782192
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ACCOMMODATING BRILLIANT CARING TRAVELS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/26/2016
-----------------------------------------------------
Last Update Date | 10/26/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2021B CUNNINGHAM DR SUITE 2
-----------------------------------------------------
City | HAMPTON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23666-3326
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-431-8574
-----------------------------------------------------
Fax | 757-262-2070
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2021B CUNNINGHAM DR SUITE 2
-----------------------------------------------------
City | HAMPTON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23666-3326
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-431-8574
-----------------------------------------------------
Fax | 757-262-2070
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | AZEEM SMITHSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 215-431-8574
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 344600000X
-----------------------------------------------------
Taxonomy Name | Taxi
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------