=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295660272
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PENINSULA CARE SHUTTLE TRANSPORT SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/12/2026
-----------------------------------------------------
Last Update Date | 06/12/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15578 CARROLLTON BLVD
-----------------------------------------------------
City | CARROLLTON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23314-2308
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-633-5375
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13176 JEFFERSON AVE STE D
-----------------------------------------------------
City | NEWPORT NEWS
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23608-1322
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-633-5375
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | PENNY MASON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 757-633-5375
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 172A00000X
-----------------------------------------------------
Taxonomy Name | Driver
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------