MEDICARE: SILVERSURF 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	320800000X	Mental Illness Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1891414397
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SILVERSURF TRANSPORTATION LLC

Provider Business Mailing Address
First Line	:	3929 DURFEE AVE
Second Line	:
City	:	EL MONTE
State	:	CA
Zip	:	91732-2507
Country	:	US
Telephone Number	:	562-479-4473
Fax Number	:

Provider Business Practice Location Address
First Line	:	3929 DURFEE AVE
Second Line	:
City	:	EL MONTE
State	:	CA
Zip	:	91732-2507
Country	:	US
Telephone Number	:	562-479-4473
Fax Number	:

Authorized Official
Title or Position	:	LICENSEE
Name	:	JONATHAN DIPALING
Credential	:
Telephone Number	:	562-479-4473

Provider Enumeration Date	:	08/26/2022
Last Update Date	:	12/26/2022

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