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General NPI Number Information
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NPI Number | 1821374091
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Entity Type | Organization
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Legal Business Name | GHOLSTON PARATRANSIT SERVICE LLC
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Dates
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Enumeration Date | 11/01/2011
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Last Update Date | 04/25/2012
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Provider Practice Location Address
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Address Line | 5070 PARKSIDE AVENUE SUITE 2100
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City | PHILADELPHIA
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State | PA
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Zip | 19131
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Country | US
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Telephone | 215-490-7929
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Fax |
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Provider Business Mailing Address
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Address Line | 140 S 44TH ST APT 3B
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City | PHILADELPHIA
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State | PA
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Zip | 19104-2989
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Country | US
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Telephone | 215-490-7929
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Fax |
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Authorized Official
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Title or Position | PRESIDENT, CEO
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Name | MR. JARRAD MARCELLAS GHOLSTON
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Credential |
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Telephone | 215-490-7929
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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 |
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License Number State |
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