Provider Demographics
NPI:1124379300
Name:CARE WAGON MEDICAL TRANSPORT LLC
Entity Type:Organization
Organization Name:CARE WAGON MEDICAL TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:IRIS
Authorized Official - Last Name:DENBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-428-2273
Mailing Address - Street 1:2026 N RIVERSIDE AVE
Mailing Address - Street 2:SUITE C177
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92377-4685
Mailing Address - Country:US
Mailing Address - Phone:909-428-2273
Mailing Address - Fax:909-600-7107
Practice Address - Street 1:3579 GOLDENROD AVE
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92377-3409
Practice Address - Country:US
Practice Address - Phone:909-428-2273
Practice Address - Fax:909-600-7107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-27
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA201208110344343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)