=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265242168
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EASY ROLLING TRANSPORTATION LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/13/2025
-----------------------------------------------------
Last Update Date | 02/16/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11357 NUCKOLS RD # 1092
-----------------------------------------------------
City | GLEN ALLEN
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23059-5504
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-516-5286
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9524 SHEPTON CIR
-----------------------------------------------------
City | HENRICO
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23294-5537
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-516-5286
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING MEMBER
-----------------------------------------------------
Name | SILENA MOTLEY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 804-516-5286
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------