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General NPI Number Information
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NPI Number | 1952942344
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Entity Type | Organization
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Legal Business Name | CARE SOURCE ONE TRANSPORTATION SERVICE LLC
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Dates
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Enumeration Date | 10/07/2019
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Last Update Date | 10/07/2019
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Provider Practice Location Address
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Address Line | 2522 LINCOLN ST
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City | HOLLYWOOD
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State | FL
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Zip | 33020-3973
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Country | US
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Telephone | 954-744-9534
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Fax |
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Provider Business Mailing Address
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Address Line | P.O. BOX 7972 PINES BLVD #246025
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City | PEMBROKE PINES
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State | FL
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Zip | 33024
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Country | US
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Telephone | 954-744-9534
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BRIDGET HAMPTON
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Credential |
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Telephone | 954-744-9534
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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