Provider Demographics
NPI:1619364270
Name:MODIVCARE SOLUTIONS, LLC
Entity Type:Organization
Organization Name:MODIVCARE SOLUTIONS, LLC
Other - Org Name:LGTC FL AHCA
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT & CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENLEAF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-486-7647
Mailing Address - Street 1:1275 PEACHTREE ST NE
Mailing Address - Street 2:6TH FLOOR
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-3580
Mailing Address - Country:US
Mailing Address - Phone:800-486-7647
Mailing Address - Fax:404-888-5999
Practice Address - Street 1:5875 NW 163RD ST STE 203
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-5618
Practice Address - Country:US
Practice Address - Phone:800-698-8457
Practice Address - Fax:305-471-0443
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MODIVCARE INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-04-22
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014158202Medicaid
FL014158204Medicaid
FL014158200Medicaid
FL014158201Medicaid
FL014158203Medicaid