MEDICARE: CHANGING LIVES TRANSPORTATION SERVICE 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	:	1629840848
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHANGING LIVES TRANSPORTATION SERVICE LLC.

Provider Business Mailing Address
First Line	:	10202 PERKINS ROWE STE E-160
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70810-2067
Country	:	US
Telephone Number	:	225-399-3148
Fax Number	:

Provider Business Practice Location Address
First Line	:	10202 PERKINS ROWE STE E-160
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70810-2067
Country	:	US
Telephone Number	:	225-399-3148
Fax Number	:

Authorized Official
Title or Position	:	CEO/MANAGER
Name	:	MS. MELISSA NICOLE EMERY
Credential	:
Telephone Number	:	225-399-3148

Provider Enumeration Date	:	10/23/2023
Last Update Date	:	10/23/2023

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