MEDICARE: SLALIAGENTLE RIDE TRANSPORTATION INC

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	:	1730663675
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SLALIAGENTLE RIDE TRANSPORTATION INC

Provider Business Mailing Address
First Line	:	11748 OXNARD ST
Second Line	:
City	:	N HOLLYWOOD
State	:	CA
Zip	:	91606-4720
Country	:	US
Telephone Number	:	747-214-5052
Fax Number	:

Provider Business Practice Location Address
First Line	:	11748 OXNARD ST
Second Line	:
City	:	N HOLLYWOOD
State	:	CA
Zip	:	91606-4720
Country	:	US
Telephone Number	:	747-214-5052
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	LIANNA MKRTCHYAN
Credential	:
Telephone Number	:	747-214-5052

Provider Enumeration Date	:	09/17/2018
Last Update Date	:	09/17/2018

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