MEDICARE: ELITE SENIOR 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	:	1619565389
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELITE SENIOR TRANSPORTATION LLC

Provider Business Mailing Address
First Line	:	3994 VILLA LAKE RD
Second Line	:
City	:	POWDER SPRINGS
State	:	GA
Zip	:	30127-5051
Country	:	US
Telephone Number	:	850-688-6761
Fax Number	:

Provider Business Practice Location Address
First Line	:	3994 VILLA LAKE RD
Second Line	:
City	:	POWDER SPRINGS
State	:	GA
Zip	:	30127-5051
Country	:	US
Telephone Number	:	850-688-6761
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	JASMIN BOOKER
Credential	:
Telephone Number	:	678-469-9526

Provider Enumeration Date	:	01/07/2021
Last Update Date	:	02/01/2021

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