MEDICARE: GRATITUDE CARE & LOGISTIC 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	:	1972348316
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRATITUDE CARE & LOGISTIC LLC

Provider Business Mailing Address
First Line	:	7782 NORTHROP DR
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92508-6085
Country	:	US
Telephone Number	:	909-758-2840
Fax Number	:	951-776-8739

Provider Business Practice Location Address
First Line	:	7782 NORTHROP DR
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92508-6085
Country	:	US
Telephone Number	:	909-758-2840
Fax Number	:	951-776-8739

Authorized Official
Title or Position	:	CEO
Name	:	MS. GAELLE N TCHOUMBA
Credential	:	RN
Telephone Number	:	909-646-2404

Provider Enumeration Date	:	06/27/2024
Last Update Date	:	06/27/2024

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