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General NPI Number Information
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NPI Number | 1932642717
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Entity Type | Organization
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Legal Business Name | CONNECTED CARE TRANSPORT INC
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Dates
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Enumeration Date | 11/28/2016
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Last Update Date | 11/28/2016
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Provider Practice Location Address
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Address Line | 5865 RIDGEWAY CENTER PKWY SUITE 300
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City | MEMPHIS
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State | TN
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Zip | 38120-4032
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Country | US
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Telephone | 855-255-7337
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Fax | 855-255-7337
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Provider Business Mailing Address
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Address Line | 5865 RIDGEWAY CENTER PKWY SUITE 300
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City | MEMPHIS
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State | TN
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Zip | 38120-4032
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Country | US
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Telephone | 855-255-7337
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Fax | 855-255-7337
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Authorized Official
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Title or Position | CEO
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Name | MS. QUAVISA NICOLE HENDERSON
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Credential | LPN
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Telephone | 855-255-7337
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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 | 090776142
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License Number State | TN
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