=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427784008
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RELIABLE TRANSPORTATION LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/27/2022
-----------------------------------------------------
Last Update Date | 07/27/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 67-183 KUOHA ST
-----------------------------------------------------
City | WAIALUA
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96791-9550
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-620-6963
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1158
-----------------------------------------------------
City | WAIALUA
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96791-1158
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-620-6963
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DUSTIN LABASAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 808-620-6963
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------