MEDICARE: PROFILE 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)	18-761-5	OH

General Provider Information

NPI Number	:	1811142607
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROFILE TRANSPORTATION LLC

Provider Business Mailing Address
First Line	:	3398 HARTWOOD RD
Second Line	:
City	:	CLEVELAND HTS
State	:	OH
Zip	:	44112-3028
Country	:	US
Telephone Number	:	216-514-9499
Fax Number	:	216-514-9499

Provider Business Practice Location Address
First Line	:	3398 HARTWOOD RD
Second Line	:
City	:	CLEVELAND HTS
State	:	OH
Zip	:	44112-3028
Country	:	US
Telephone Number	:	216-514-9499
Fax Number	:	216-514-9499

Authorized Official
Title or Position	:	GENERAL MANAGER
Name	:	MS. SAMATHA A BURNS
Credential	:
Telephone Number	:	216-514-9499

Provider Enumeration Date	:	11/21/2008
Last Update Date	:	11/21/2008

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