Provider Demographics
NPI:1790326924
Name:SEABREEZE NON EMERGENCY MEDICAL TRANSPORT, LLC
Entity Type:Organization
Organization Name:SEABREEZE NON EMERGENCY MEDICAL TRANSPORT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRISA
Authorized Official - Middle Name:
Authorized Official - Last Name:BERUMEN-DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-670-1499
Mailing Address - Street 1:1016 KINGSWAY AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61108-3857
Mailing Address - Country:US
Mailing Address - Phone:815-670-1499
Mailing Address - Fax:
Practice Address - Street 1:1016 KINGSWAY AVE
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-3857
Practice Address - Country:US
Practice Address - Phone:815-670-1499
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-29
Last Update Date:2019-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)