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General NPI Number Information
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NPI Number | 1700607025
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Entity Type | Organization
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Legal Business Name | SBW FAMILY TRANSPORTATION LLC
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Dates
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Enumeration Date | 10/19/2024
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Last Update Date | 10/19/2024
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Provider Practice Location Address
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Address Line | 2017 219TH PL
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City | SAUK VILLAGE
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State | IL
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Zip | 60411-5005
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Country | US
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Telephone | 219-281-9245
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Fax |
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Provider Business Mailing Address
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Address Line | 2017 219TH PL
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City | SAUK VILLAGE
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State | IL
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Zip | 60411-5005
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Country | US
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Telephone | 219-281-9245
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Fax |
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Authorized Official
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Title or Position | MANAGER/OWNER
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Name | BLAKE WILKINS SR.
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Credential |
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Telephone | 219-281-9245
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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 |
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License Number State |
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