Provider Demographics
NPI:1629746011
Name:DIRECT CARE TRANSPORT LLC
Entity Type:Organization
Organization Name:DIRECT CARE TRANSPORT LLC
Other - Org Name:DIRECT CARE TRANSPORT LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHEM
Authorized Official - Middle Name:
Authorized Official - Last Name:HODGES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-549-3655
Mailing Address - Street 1:1594 STABLE PARK CT
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-6193
Mailing Address - Country:US
Mailing Address - Phone:901-549-3655
Mailing Address - Fax:
Practice Address - Street 1:1594 STABLE PARK CT
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38016-6193
Practice Address - Country:US
Practice Address - Phone:901-549-3655
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-01
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriverGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ068754Medicaid