Provider Demographics
NPI:1073228904
Name:SOCIAL LOCOMOTION LLC
Entity Type:Organization
Organization Name:SOCIAL LOCOMOTION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SADE
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-544-9962
Mailing Address - Street 1:PO BOX 220231
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28222-0231
Mailing Address - Country:US
Mailing Address - Phone:916-544-9962
Mailing Address - Fax:
Practice Address - Street 1:4556 RANDOLPH RD APT 92
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-2964
Practice Address - Country:US
Practice Address - Phone:916-544-9962
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-16
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)