MEDICARE: RUACH 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	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1558191395
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RUACH TRANSPORTATION LLC

Provider Business Mailing Address
First Line	:	16916 SUNSET RIDGE DR
Second Line	:
City	:	COUNTRY CLUB HILLS
State	:	IL
Zip	:	60478-2154
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	16916 SUNSET RIDGE DR
Second Line	:
City	:	COUNTRY CLUB HILLS
State	:	IL
Zip	:	60478-2154
Country	:	US
Telephone Number	:	708-864-0254
Fax Number	:

Authorized Official
Title or Position	:	CEO/ OWNER/OPERATOR
Name	:	TIARA JAKES
Credential	:
Telephone Number	:	708-864-0254

Provider Enumeration Date	:	08/06/2024
Last Update Date	:	08/06/2024

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Directions to “RUACH TRANSPORTATION LLC ” Practice Location

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