Provider Demographics
NPI:1033647219
Name:MANCARE MEDICAL TRANSPORTATION LLC
Entity Type:Organization
Organization Name:MANCARE MEDICAL TRANSPORTATION LLC
Other - Org Name:MANCARE
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:OSEI
Authorized Official - Last Name:OPARE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-241-2493
Mailing Address - Street 1:108 GOLD VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:LOCUST GROVE
Mailing Address - State:VA
Mailing Address - Zip Code:22508
Mailing Address - Country:US
Mailing Address - Phone:540-744-1020
Mailing Address - Fax:540-404-8254
Practice Address - Street 1:108 GOLD VALLEY RD
Practice Address - Street 2:
Practice Address - City:LOCUST GROVE
Practice Address - State:VA
Practice Address - Zip Code:22508
Practice Address - Country:US
Practice Address - Phone:540-744-1020
Practice Address - Fax:540-404-8254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA697032998Medicaid
VAA6389039Medicaid