Provider Demographics
NPI:1003208752
Name:SPECIAL CARE TRANSPORTAION
Entity Type:Organization
Organization Name:SPECIAL CARE TRANSPORTAION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALVIN
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:708-481-9849
Mailing Address - Street 1:21121 CHRISTINA DR
Mailing Address - Street 2:
Mailing Address - City:MATTESON
Mailing Address - State:IL
Mailing Address - Zip Code:60443-3003
Mailing Address - Country:US
Mailing Address - Phone:708-481-9849
Mailing Address - Fax:
Practice Address - Street 1:21121 CHRISTINA DR
Practice Address - Street 2:
Practice Address - City:MATTESON
Practice Address - State:IL
Practice Address - Zip Code:60443-3003
Practice Address - Country:US
Practice Address - Phone:708-481-9849
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-03
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)