Provider Demographics
NPI:1346936739
Name:ALL SMILES NEMT
Entity Type:Organization
Organization Name:ALL SMILES NEMT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:SEAN
Authorized Official - Last Name:PETTIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:669-293-8899
Mailing Address - Street 1:2951 DERBY ST APT 121
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-1352
Mailing Address - Country:US
Mailing Address - Phone:669-293-8899
Mailing Address - Fax:
Practice Address - Street 1:2951 DERBY ST APT 121
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-1352
Practice Address - Country:US
Practice Address - Phone:669-293-8899
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)