Provider Demographics
NPI:1598047144
Name:CHARIS TRANSPORTATION
Entity Type:Organization
Organization Name:CHARIS TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:BERNARDINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-552-4567
Mailing Address - Street 1:802 DANIELS AVE
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94590-3013
Mailing Address - Country:US
Mailing Address - Phone:707-552-4567
Mailing Address - Fax:707-642-4775
Practice Address - Street 1:802 DANIELS AVE
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94590-3013
Practice Address - Country:US
Practice Address - Phone:707-552-4567
Practice Address - Fax:707-642-4775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-09
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12-00011544343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)