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General NPI Number Information
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NPI Number | 1932651957
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Entity Type | Organization
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Legal Business Name | LILLIAS NONE EMERGENCY TRANSPORTATION
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Dates
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Enumeration Date | 10/25/2016
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Last Update Date | 10/25/2016
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Provider Practice Location Address
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Address Line | 10070 GRAYTON ST
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City | DETROIT
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State | MI
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Zip | 48224-1940
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Country | US
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Telephone | 313-587-4228
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Fax |
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Provider Business Mailing Address
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Address Line | 10070 GRAYTON
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City | DETROIT
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State | MI
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Zip | 48224
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Country | US
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Telephone | 313-587-4228
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Fax |
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Authorized Official
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Title or Position | OWNER OPERATOR
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Name | JERRY JOHN THOMPSON
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Credential | PARAMEDIC
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Telephone | 313-587-4228
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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 | T512402429815
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License Number State | MI
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