=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396657839
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AGING HEARTS TRANSPORTATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/21/2026
-----------------------------------------------------
Last Update Date | 09/21/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1061 MARTIN PL
-----------------------------------------------------
City | VALLEY STREAM
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11580-1349
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-553-5774
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1061 MARTIN PL
-----------------------------------------------------
City | VALLEY STREAM
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11580-1349
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-553-5774
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | TERELL MATTHEWS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 917-553-5774
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171WV0202X
-----------------------------------------------------
Taxonomy Name | Vehicle Modifications Contractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------