MEDICARE: LUCKY DOG CARE 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	:	1043001167
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUCKY DOG CARE LLC

Provider Business Mailing Address
First Line	:	2833 N SOMERSET ST
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22213-1219
Country	:	US
Telephone Number	:	571-591-9951
Fax Number	:

Provider Business Practice Location Address
First Line	:	2833 N SOMERSET ST
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22213-1219
Country	:	US
Telephone Number	:	571-591-9951
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	SEADA AWEL
Credential	:
Telephone Number	:	571-591-9951

Provider Enumeration Date	:	05/16/2025
Last Update Date	:	05/16/2025

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Directions to “LUCKY DOG CARE LLC ” Practice Location

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