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General NPI Number Information
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NPI Number | 1285437996
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Entity Type | Organization
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Legal Business Name | SANCTUARY PERSONAL SERVICE AGENCY
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Dates
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Enumeration Date | 03/28/2025
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Last Update Date | 03/28/2025
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Provider Practice Location Address
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Address Line | 1901 E 800 N
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City | WEST LAFAYETTE
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State | IN
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Zip | 47906-9009
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Country | US
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Telephone | 765-409-0980
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Fax |
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Provider Business Mailing Address
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Address Line | 5475 BROADWAY UNIT A286
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City | MERRILLVILLE
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State | IN
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Zip | 46410-1647
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Country | US
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Telephone | 765-409-0980
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | TAJA J CALVIN
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Credential |
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Telephone | 765-231-5013
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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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