MEDICARE: LIGHTYEAR COMMUTE 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	347C00000X	Private Vehicle
2	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1881361392
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIGHTYEAR COMMUTE LLC

Provider Business Mailing Address
First Line	:	PO BOX 1613
Second Line	:
City	:	CHESTERFIELD
State	:	VA
Zip	:	23832-9125
Country	:	US
Telephone Number	:	804-256-8533
Fax Number	:	804-362-9003

Provider Business Practice Location Address
First Line	:	11300 IRON BRIDGE RD STE D
Second Line	:
City	:	CHESTER
State	:	VA
Zip	:	23831-1428
Country	:	US
Telephone Number	:	804-256-8533
Fax Number	:	804-362-9003

Authorized Official
Title or Position	:	OWNER
Name	:	CARA MELLANSON
Credential	:	QMHP
Telephone Number	:	804-256-8533

Provider Enumeration Date	:	08/24/2021
Last Update Date	:	08/24/2021

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Directions to “LIGHTYEAR COMMUTE LLC ” Practice Location

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