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General NPI Number Information
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NPI Number | 1679886782
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Entity Type | Organization
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Legal Business Name | REDIVAN INC
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Dates
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Enumeration Date | 07/17/2010
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Last Update Date | 07/17/2010
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Provider Practice Location Address
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Address Line | 69 BEETHOVEN ST
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City | BINGHAMTON
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State | NY
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Zip | 13905-4233
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Country | US
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Telephone | 607-760-8013
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Fax | 607-217-5397
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Provider Business Mailing Address
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Address Line | 69 BEETHOVEN ST
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City | BINGHAMTON
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State | NY
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Zip | 13905-4233
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Country | US
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Telephone | 607-760-8013
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Fax | 607-217-5397
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. SARAH ELIZABETH JACKSON
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Credential |
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Telephone | 607-235-9112
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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 | 37792
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License Number State | NY
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