Provider Demographics
NPI:1447749650
Name:EUNICE MEDICAL TRANSPORTATION SERVICE LLC.
Entity Type:Organization
Organization Name:EUNICE MEDICAL TRANSPORTATION SERVICE LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:NOAH
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-339-4985
Mailing Address - Street 1:PO BOX 6961
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22195-6961
Mailing Address - Country:US
Mailing Address - Phone:571-339-4985
Mailing Address - Fax:
Practice Address - Street 1:675 BERRYVILLE AVE
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-5663
Practice Address - Country:US
Practice Address - Phone:571-339-4985
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-02
Last Update Date:2018-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA=========Medicaid