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General NPI Number Information
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NPI Number | 1992043426
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Entity Type | Organization
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Legal Business Name | COACH DREAMMAKERS L.L.C.
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Dates
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Enumeration Date | 01/17/2013
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Last Update Date | 01/17/2013
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Provider Practice Location Address
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Address Line | 5435 EMERSON WAY STE 210
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City | INDIANAPOLIS
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State | IN
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Zip | 46226-1469
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Country | US
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Telephone | 317-758-7518
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Fax |
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Provider Business Mailing Address
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Address Line | 3136 W 21ST ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46222-4802
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Country | US
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Telephone | 317-513-2386
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Fax | 317-917-1720
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Authorized Official
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Title or Position | OWNER
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Name | MR. RICKY BUCKLEY JR.
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Credential |
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Telephone | 317-513-2386
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343800000X
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Taxonomy Name | Secured Medical Transport (VAN)
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License Number | 2330496686
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 347B00000X
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Taxonomy Name | Bus
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License Number | 2330496686
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number | 2330496686
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License Number State | IN
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