=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689067761
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SENIOR CARE SERVICES & TRANSPORT,LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/12/2015
-----------------------------------------------------
Last Update Date | 03/12/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1088 PRIMROSE LN
-----------------------------------------------------
City | MILAN
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48160-1451
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-356-6898
-----------------------------------------------------
Fax | 248-356-4098
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1088 PRIMROSE LN
-----------------------------------------------------
City | MILAN
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48160-1451
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-356-6898
-----------------------------------------------------
Fax | 248-356-4098
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO/PRESIDENT
-----------------------------------------------------
Name | MRS. ALICE LUVENIA SMITH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 248-356-6898
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number | E4650M
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------