MEDICARE: ADDE TRANSPORT 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	:	1033886999
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADDE TRANSPORT LLC

Provider Business Mailing Address
First Line	:	PO BOX 663
Second Line	:
City	:	LEMON GROVE
State	:	CA
Zip	:	91946-0663
Country	:	US
Telephone Number	:	619-730-5025
Fax Number	:

Provider Business Practice Location Address
First Line	:	5040 KEENEY ST APT 40
Second Line	:
City	:	LA MESA
State	:	CA
Zip	:	91942-7459
Country	:	US
Telephone Number	:	619-730-5025
Fax Number	:

Authorized Official
Title or Position	:	MANAGING PARTNER
Name	:	MR. MUSTAF SUFI ADDE
Credential	:
Telephone Number	:	619-730-5025

Provider Enumeration Date	:	08/26/2021
Last Update Date	:	08/26/2021

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Directions to “ADDE TRANSPORT LLC ” Practice Location

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