MEDICARE: EXTENDING ARMS 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)
2	347C00000X	Private Vehicle

General Provider Information

NPI Number	:	1730913559
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXTENDING ARMS TRANSPORTATION LLC

Provider Business Mailing Address
First Line	:	1317 EDGEWATER DR STE 3153
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32804-6350
Country	:	US
Telephone Number	:	407-970-8921
Fax Number	:

Provider Business Practice Location Address
First Line	:	1317 EDGEWATER DR STE 3153
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32804-6350
Country	:	US
Telephone Number	:	407-970-8921
Fax Number	:

Authorized Official
Title or Position	:	MBR
Name	:	YESENIA A DOMENECH
Credential	:
Telephone Number	:	407-970-8921

Provider Enumeration Date	:	08/26/2024
Last Update Date	:	08/26/2024

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