Provider Demographics
NPI:1114435534
Name:ENSURED TRANSPO CARE LLC.
Entity Type:Organization
Organization Name:ENSURED TRANSPO CARE LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:LADAMIYA
Authorized Official - Middle Name:JOHNTA KARELL
Authorized Official - Last Name:FLETCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-453-4236
Mailing Address - Street 1:769 DORY DR
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70056-8682
Mailing Address - Country:US
Mailing Address - Phone:337-258-2621
Mailing Address - Fax:
Practice Address - Street 1:510 PARISH RD
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-2244
Practice Address - Country:US
Practice Address - Phone:337-258-2621
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-19
Last Update Date:2018-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical