MEDICARE: SAFEWAY NON-EMERGENCY MEDICAL TRANSPORTATION

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	:	1225326531
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAFEWAY NON-EMERGENCY MEDICAL TRANSPORTATION

Provider Business Mailing Address
First Line	:	5301 LAUREL CANYON BLVD SUIT 250
Second Line	:
City	:	VALLEY VILLAGE
State	:	CA
Zip	:	91607-2736
Country	:	US
Telephone Number	:	818-764-8000
Fax Number	:	818-787-1887

Provider Business Practice Location Address
First Line	:	5301 LAUREL CANYON BLVD SUIT 250
Second Line	:
City	:	VALLEY VILLAGE
State	:	CA
Zip	:	91607-2736
Country	:	US
Telephone Number	:	818-764-8000
Fax Number	:	818-787-1887

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. ARTUR GRIGORYAN
Credential	:
Telephone Number	:	818-339-1010

Provider Enumeration Date	:	07/20/2011
Last Update Date	:	03/26/2014

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Directions to “SAFEWAY NON-EMERGENCY MEDICAL TRANSPORTATION ” Practice Location

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