Provider Demographics
NPI:1396005385
Name:MOBILE CARE TRANSPORT INC
Entity Type:Organization
Organization Name:MOBILE CARE TRANSPORT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DACKERY
Authorized Official - Middle Name:GLENN
Authorized Official - Last Name:HARDEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-501-7732
Mailing Address - Street 1:8250 CALVINE RD
Mailing Address - Street 2:BOX 253
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95828-9313
Mailing Address - Country:US
Mailing Address - Phone:916-501-7732
Mailing Address - Fax:916-583-7571
Practice Address - Street 1:7200 JACINTO AVE
Practice Address - Street 2:#15205
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-7555
Practice Address - Country:US
Practice Address - Phone:916-501-7732
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-23
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)