MEDICARE: CARE DRIVE NEMT 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	:	1376352088
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARE DRIVE NEMT LLC

Provider Business Mailing Address
First Line	:	1712 CRYSTAL DOWNS AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-2413
Country	:	US
Telephone Number	:	702-569-5932
Fax Number	:

Provider Business Practice Location Address
First Line	:	1712 CRYSTAL DOWNS AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-2413
Country	:	US
Telephone Number	:	702-708-5875
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	KELVIN K BLACKMAN JR.
Credential	:
Telephone Number	:	702-981-1310

Provider Enumeration Date	:	01/07/2025
Last Update Date	:	01/18/2025

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