Provider Demographics
NPI:1689829608
Name:CHOICE CARE TRANSPORT LLC
Entity Type:Organization
Organization Name:CHOICE CARE TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:OLAKUNLE
Authorized Official - Middle Name:I
Authorized Official - Last Name:SANYAOLU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-406-1378
Mailing Address - Street 1:8662 W MEDFORD AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53225-2823
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8662 W MEDFORD AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53225-2823
Practice Address - Country:US
Practice Address - Phone:414-393-1944
Practice Address - Fax:414-535-0762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-18
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41499700Medicaid