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NPI Code Detail

MEDICARE: CONNECT CARE TRANS LLC

MEDICARE: CONNECT CARE TRANS 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
1347C00000XPrivate Vehicle

General Provider Information

NPI Number : 1407462336
Entity Type Code : Organization
Provider Name (Legal Business Name) : CONNECT CARE TRANS LLC
Provider Business Mailing Address
First Line : 2454 W PETERSON AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60659-4113
Country : US
Telephone Number : 773-297-8000
Fax Number : 773-326-2455
Provider Business Practice Location Address
First Line : 2454 W PETERSON AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60659-4113
Country : US
Telephone Number : 773-297-8000
Fax Number : 773-326-2455
Authorized Official
Title or Position : PRESIDENT
Name : AHMED H JIMALE
Credential :
Telephone Number : 773-297-8000
Provider Enumeration Date : 09/16/2020
Last Update Date : 11/02/2020

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Directions to “CONNECT CARE TRANS LLC ” Practice Location

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