MEDICARE: FAMILY LOVE 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	:	1821713991
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY LOVE TRANSPORTATION LLC

Provider Business Mailing Address
First Line	:	5528 GREEN FOREST DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32244-1548
Country	:	US
Telephone Number	:	904-844-1703
Fax Number	:	904-683-9398

Provider Business Practice Location Address
First Line	:	5528 GREEN FOREST DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32244-1548
Country	:	US
Telephone Number	:	904-844-1703
Fax Number	:	904-683-9398

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. CARLA NICHELL MCKENZY-COOKS
Credential	:
Telephone Number	:	904-844-1703

Provider Enumeration Date	:	10/11/2022
Last Update Date	:	10/11/2022

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