Provider Demographics
NPI:1821374091
Name:GHOLSTON PARATRANSIT SERVICE LLC
Entity Type:Organization
Organization Name:GHOLSTON PARATRANSIT SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JARRAD
Authorized Official - Middle Name:MARCELLAS
Authorized Official - Last Name:GHOLSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-490-7929
Mailing Address - Street 1:140 S 44TH ST
Mailing Address - Street 2:APT 3B
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-2989
Mailing Address - Country:US
Mailing Address - Phone:215-490-7929
Mailing Address - Fax:
Practice Address - Street 1:5070 PARKSIDE AVENUE
Practice Address - Street 2:SUITE 2100
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19131
Practice Address - Country:US
Practice Address - Phone:215-490-7929
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-01
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)