MEDICARE: GOLDEN HANDS TRANSPORTATION 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	343800000X	Secured Medical Transport (VAN)	1600331	IN
2	343900000X	Non-emergency Medical Transport (VAN)	1600331	IN

General Provider Information

NPI Number	:	1376727339
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOLDEN HANDS TRANSPORTATION LLC.

Provider Business Mailing Address
First Line	:	624 E WAYNE ST
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46802-2016
Country	:	US
Telephone Number	:	260-557-7004
Fax Number	:	260-338-0584

Provider Business Practice Location Address
First Line	:	624 E WAYNE ST
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46802-2016
Country	:	US
Telephone Number	:	260-557-7004
Fax Number	:	260-338-0584

Authorized Official
Title or Position	:	OPERATION MANAGER
Name	:	MOUSSA I DAHAB
Credential	:	OWNER
Telephone Number	:	260-557-7004

Provider Enumeration Date	:	12/26/2007
Last Update Date	:	12/26/2007

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