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General NPI Number Information
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NPI Number | 1922533942
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Entity Type | Organization
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Legal Business Name | EXTRA CARE MEDICAL TRANSPORT
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Dates
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Enumeration Date | 04/27/2017
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Last Update Date | 04/27/2017
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Provider Practice Location Address
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Address Line | 5150 CANDLEWOOD ST SUITE 17 F
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City | LAKEWOOD
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State | CA
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Zip | 90712-1925
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Country | US
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Telephone | 323-422-2512
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Fax |
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Provider Business Mailing Address
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Address Line | 5150 CANDLEWOOD STREET SUITE 17 F
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City | LAKEWOOD
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State | CA
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Zip | 90217-1927
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Country | US
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Telephone | 323-422-2512
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. SENECA MONET WALKER
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Credential |
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Telephone | 323-422-2512
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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 | 20080705
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License Number State | CA
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