Provider Demographics
NPI:1801385737
Name:TEAM4 TRANSPORT LLC
Entity Type:Organization
Organization Name:TEAM4 TRANSPORT LLC
Other - Org Name:LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA TERESA
Authorized Official - Middle Name:HORLADOR
Authorized Official - Last Name:BLIVEN
Authorized Official - Suffix:
Authorized Official - Credentials:OCCUPATIONAL THERAPI
Authorized Official - Phone:386-383-1400
Mailing Address - Street 1:911 E FAIRBAIRN DR
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32725-6955
Mailing Address - Country:US
Mailing Address - Phone:386-383-1400
Mailing Address - Fax:386-753-5071
Practice Address - Street 1:911 E FAIRBAIRN DR
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32725-6955
Practice Address - Country:US
Practice Address - Phone:386-383-1400
Practice Address - Fax:386-753-5071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-07
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20019343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)