Provider Demographics
NPI:1093580375
Name:COMFORT CARE TRANSPORT LLC
Entity Type:Organization
Organization Name:COMFORT CARE TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROXANNE
Authorized Official - Middle Name:LISA
Authorized Official - Last Name:LUKENBILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-748-5397
Mailing Address - Street 1:1110 COWAN RD STE B PMB 2266
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39507-3441
Mailing Address - Country:US
Mailing Address - Phone:228-346-4644
Mailing Address - Fax:
Practice Address - Street 1:2707 BROADMOOR PL
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39501-5346
Practice Address - Country:US
Practice Address - Phone:228-346-4644
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-16
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)