MEDICARE: ELYASO LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1013752807
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELYASO LLC

Provider Business Mailing Address
First Line	:	6635 MAYBURN ST
Second Line	:
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48127-2265
Country	:	US
Telephone Number	:	313-529-1107
Fax Number	:

Provider Business Practice Location Address
First Line	:	6635 MAYBURN ST
Second Line	:
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48127-2265
Country	:	US
Telephone Number	:	313-529-1107
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	HUSSEIN ALHASANI
Credential	:
Telephone Number	:	313-529-1107

Provider Enumeration Date	:	06/25/2024
Last Update Date	:	04/21/2025

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