MEDICARE: SANCTUARY PERSONAL SERVICE AGENCY

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	:	1285437996
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANCTUARY PERSONAL SERVICE AGENCY

Provider Business Mailing Address
First Line	:	5475 BROADWAY UNIT A286
Second Line	:
City	:	MERRILLVILLE
State	:	IN
Zip	:	46410-1647
Country	:	US
Telephone Number	:	765-409-0980
Fax Number	:

Provider Business Practice Location Address
First Line	:	1901 E 800 N
Second Line	:
City	:	WEST LAFAYETTE
State	:	IN
Zip	:	47906-9009
Country	:	US
Telephone Number	:	765-409-0980
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	TAJA J CALVIN
Credential	:
Telephone Number	:	765-231-5013

Provider Enumeration Date	:	03/28/2025
Last Update Date	:	03/28/2025

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