MEDICARE: GROWING DEVELOPMENTS TRANSPORTATION SERVICES, 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	:	1093268690
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GROWING DEVELOPMENTS TRANSPORTATION SERVICES, LLC

Provider Business Mailing Address
First Line	:	3900 W BROWN DEER RD
Second Line	:	SUITE A
City	:	MILWAUKEE
State	:	WI
Zip	:	53209-1220
Country	:	US
Telephone Number	:	888-855-4373
Fax Number	:	920-267-6302

Provider Business Practice Location Address
First Line	:	3900 W BROWN DEER RD
Second Line	:	SUITE A
City	:	MILWAUKEE
State	:	WI
Zip	:	53209-1220
Country	:	US
Telephone Number	:	888-855-4373
Fax Number	:	920-267-6302

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	NEQUILIA EARNEST
Credential	:
Telephone Number	:	888-855-4373

Provider Enumeration Date	:	07/31/2016
Last Update Date	:	07/31/2016

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