Provider Demographics
NPI:1609574433
Name:SHADDAI AMBULANCE SERVICES LLC
Entity Type:Organization
Organization Name:SHADDAI AMBULANCE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALEJANDRO
Authorized Official - Middle Name:
Authorized Official - Last Name:DE JESUS BURGOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-397-7615
Mailing Address - Street 1:HC 2 BOX 4467
Mailing Address - Street 2:
Mailing Address - City:VILLALBA
Mailing Address - State:PR
Mailing Address - Zip Code:00766-9757
Mailing Address - Country:US
Mailing Address - Phone:787-397-7615
Mailing Address - Fax:
Practice Address - Street 1:BO HIGUERO CARR 150 KM 7.3
Practice Address - Street 2:
Practice Address - City:VILLALBA
Practice Address - State:PR
Practice Address - Zip Code:00766
Practice Address - Country:US
Practice Address - Phone:787-397-7615
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-21
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport