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General NPI Number Information
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NPI Number | 1619235785
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Entity Type | Organization
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Legal Business Name | BROTHER 2 BROTHER NON EMERGENCY TRANSPORTATION LIMO SERVICE, LLC
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Dates
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Enumeration Date | 04/26/2012
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Last Update Date | 04/26/2012
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Provider Practice Location Address
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Address Line | 805 DAYNA DR
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City | COLLEGE PARK
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State | GA
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Zip | 30349-6785
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Country | US
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Telephone | 678-608-6651
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Fax |
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Provider Business Mailing Address
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Address Line | 805 DAYNA DR
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City | COLLEGE PARK
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State | GA
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Zip | 30349-6785
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Country | US
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Telephone | 678-608-6651
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Fax | 206-666-6398
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Authorized Official
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Title or Position | MANAGER
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Name | MR. KELVIN L MILNER
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Credential |
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Telephone | 678-608-6651
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number | 004084987
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License Number State | GA
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