=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659738508
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | S&H TRANSPORTATION LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/23/2016
-----------------------------------------------------
Last Update Date | 01/23/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3407 22ND ST S APT 104
-----------------------------------------------------
City | SAINT CLOUD
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56301-5079
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 320-248-9980
-----------------------------------------------------
Fax | 320-240-8088
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3407 22ND ST S APT 104
-----------------------------------------------------
City | SAINT CLOUD
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56301-5079
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 320-248-9980
-----------------------------------------------------
Fax | 320-240-8088
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | NON MEDICAL TRANSPORTATION DRIVER
-----------------------------------------------------
Name | MR. SALEEBAAN MAXAMED ADAN
-----------------------------------------------------
Credential | DRIVER
-----------------------------------------------------
Telephone | 320-248-9980
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number | K161149202608
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------