Provider Demographics
NPI:1477685634
Name:RHONDA'S GENTLE CARE TRANSPORTATION
Entity Type:Organization
Organization Name:RHONDA'S GENTLE CARE TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:TENEISHAE
Authorized Official - Middle Name:L
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-647-6817
Mailing Address - Street 1:3910 TIMBERLEA COURT
Mailing Address - Street 2:
Mailing Address - City:COUNTRY CLUB HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60478
Mailing Address - Country:US
Mailing Address - Phone:708-647-6817
Mailing Address - Fax:708-647-6817
Practice Address - Street 1:3910 171ST PL
Practice Address - Street 2:
Practice Address - City:COUNTRY CLUB HILLS
Practice Address - State:IL
Practice Address - Zip Code:60478-4635
Practice Address - Country:US
Practice Address - Phone:708-647-6817
Practice Address - Fax:708-647-6817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL5853343800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343800000XTransportation ServicesSecured Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========Medicaid
IL=========OtherTRANSPORTATION
IL=========Medicare ID - Type UnspecifiedTRANSPORTATION
IL=========Medicaid