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General NPI Number Information
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NPI Number | 1609752963
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Entity Type | Organization
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Legal Business Name | FAITHFUL PHOENIX EXPRESS
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Dates
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Enumeration Date | 08/13/2025
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Last Update Date | 08/13/2025
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Provider Practice Location Address
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Address Line | 3100 E 45TH ST
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City | CLEVELAND
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State | OH
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Zip | 44127-1088
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Country | US
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Telephone | 216-417-4932
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Fax |
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Provider Business Mailing Address
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Address Line | 2219 WILLOWDALE AVE
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City | CLEVELAND
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State | OH
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Zip | 44109-2840
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Country | US
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Telephone | 216-374-5256
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Fax |
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Authorized Official
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Title or Position | MANAGING OWNER
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Name | MS. TRACEY SHORTS
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Credential |
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Telephone | 216-374-5256
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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