Provider Demographics
NPI:1104178755
Name:EXTRA CARE TRANSPORTATION,LLC
Entity Type:Organization
Organization Name:EXTRA CARE TRANSPORTATION,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALGASSIMU
Authorized Official - Middle Name:MONOMA
Authorized Official - Last Name:BAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-970-6582
Mailing Address - Street 1:800 COTTMAN AVE
Mailing Address - Street 2:B-173
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19111-3056
Mailing Address - Country:US
Mailing Address - Phone:267-970-6582
Mailing Address - Fax:
Practice Address - Street 1:800 COTTMAN AVE
Practice Address - Street 2:B-173
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19111-3056
Practice Address - Country:US
Practice Address - Phone:267-970-6582
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-05
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)