Provider Demographics
NPI:1760131528
Name:PRE-DESTINATION ELDERLY & HANDICAP LLC
Entity Type:Organization
Organization Name:PRE-DESTINATION ELDERLY & HANDICAP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REGINAL
Authorized Official - Middle Name:
Authorized Official - Last Name:PREDESTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-572-6065
Mailing Address - Street 1:250 N BISHOP AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06610-2455
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:250 N BISHOP AVE APT 2
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06610-2455
Practice Address - Country:US
Practice Address - Phone:203-572-6065
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-21
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)