Provider Demographics
NPI:1356849251
Name:EXECUTIVE NON-EMERGENCY TRANSPORTATION, INC.
Entity Type:Organization
Organization Name:EXECUTIVE NON-EMERGENCY TRANSPORTATION, INC.
Other - Org Name:ENET, INC.
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER / CEO
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:RICARDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-752-0004
Mailing Address - Street 1:3155-02 SUNTREE BLVD
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940
Mailing Address - Country:US
Mailing Address - Phone:321-752-0004
Mailing Address - Fax:321-722-7315
Practice Address - Street 1:3155-02 SUNTREE BLVD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940
Practice Address - Country:US
Practice Address - Phone:321-752-0004
Practice Address - Fax:321-722-7315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-25
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL885046905343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)