=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649500919
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GERRIDEN TRANSPORT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/07/2010
-----------------------------------------------------
Last Update Date | 01/07/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14566 FORRER ST
-----------------------------------------------------
City | DETROIT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48227-2200
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-587-9875
-----------------------------------------------------
Fax | 313-837-4788
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14566 FORRER ST
-----------------------------------------------------
City | DETROIT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48227-2200
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-587-9875
-----------------------------------------------------
Fax | 313-837-4788
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT, CEO
-----------------------------------------------------
Name | MRS. GERALDINE HOOKS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 313-837-4788
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343800000X
-----------------------------------------------------
Taxonomy Name | Secured Medical Transport (VAN)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------