=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497112148
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FARRELL'S TRANSPORTATION AND HEALTHCARE SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/26/2016
-----------------------------------------------------
Last Update Date | 01/26/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1521 SPANISH OAKS DR
-----------------------------------------------------
City | HARVEY
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70058-3056
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-224-0743
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1521 SPANISH OAKS DR
-----------------------------------------------------
City | HARVEY
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70058-3056
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. DARREN KEITH FARRELL SR.
-----------------------------------------------------
Credential | LPN
-----------------------------------------------------
Telephone | 504-224-0743
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number | 4663050
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------