Provider Demographics
NPI:1427385665
Name:ADVANTRAN WHEELCHAIR TRANSPORTATION LLC
Entity Type:Organization
Organization Name:ADVANTRAN WHEELCHAIR TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-529-2928
Mailing Address - Street 1:8511 DAVIS LAKE PKWY
Mailing Address - Street 2:STE C6-262
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-0536
Mailing Address - Country:US
Mailing Address - Phone:704-529-2928
Mailing Address - Fax:866-553-7489
Practice Address - Street 1:8511 DAVIS LAKE PKWY
Practice Address - Street 2:STE C6-262
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-0536
Practice Address - Country:US
Practice Address - Phone:704-529-2928
Practice Address - Fax:866-553-7489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-09
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9868492343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)