=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457664252
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VALLEY CARE MEDICAL TRANSPORTATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/21/2010
-----------------------------------------------------
Last Update Date | 07/21/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2121 S 48TH ST SUITE 104
-----------------------------------------------------
City | TEMPE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85282-1015
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-437-0106
-----------------------------------------------------
Fax | 602-437-0109
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2559 W TAMARISK AVE
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85041-2041
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-697-0429
-----------------------------------------------------
Fax | 602-437-0109
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MR. ABDELRAHIM ABDELRAHMAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 602-697-0429
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number | 478952
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------