Provider Demographics
NPI:1457664252
Name:VALLEY CARE MEDICAL TRANSPORTATION
Entity Type:Organization
Organization Name:VALLEY CARE MEDICAL TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ABDELRAHIM
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDELRAHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-697-0429
Mailing Address - Street 1:2559 W TAMARISK AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85041-2041
Mailing Address - Country:US
Mailing Address - Phone:602-697-0429
Mailing Address - Fax:602-437-0109
Practice Address - Street 1:2121 S 48TH ST
Practice Address - Street 2:SUITE 104
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-1015
Practice Address - Country:US
Practice Address - Phone:602-437-0106
Practice Address - Fax:602-437-0109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-21
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ478952343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ478952Medicaid