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General NPI Number Information
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NPI Number | 1942024195
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Entity Type | Organization
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Legal Business Name | EL SHADDAI NEMT TRANSPORTATION
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Dates
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Enumeration Date | 11/14/2024
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Last Update Date | 11/14/2024
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Provider Practice Location Address
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Address Line | 1206 BAYOU PASS DR
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City | RUSKIN
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State | FL
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Zip | 33570-5409
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Country | US
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Telephone | 727-222-8874
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Fax |
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Provider Business Mailing Address
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Address Line | 702 CRISTELLE JEAN DR
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City | RUSKIN
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State | FL
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Zip | 33570-7930
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Country | US
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Telephone | 727-222-8874
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARC SAINTIDOR
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Credential | NEMT TRANSPORTATION
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Telephone | 727-222-8874
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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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