Provider Demographics
NPI:1376302125
Name:SERENECARE TRANSPORT
Entity Type:Organization
Organization Name:SERENECARE TRANSPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED MEMBER (AMBR)
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:B
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-515-7172
Mailing Address - Street 1:9743 SW 59TH ST
Mailing Address - Street 2:
Mailing Address - City:COOPER CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33328-5737
Mailing Address - Country:US
Mailing Address - Phone:786-515-7172
Mailing Address - Fax:
Practice Address - Street 1:9743 SW 59TH ST
Practice Address - Street 2:
Practice Address - City:COOPER CITY
Practice Address - State:FL
Practice Address - Zip Code:33328-5737
Practice Address - Country:US
Practice Address - Phone:786-515-7172
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-14
Last Update Date:2024-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)