Provider Demographics
NPI:1851727630
Name:GOD'S ELECT TRANSPORTATION LLC
Entity Type:Organization
Organization Name:GOD'S ELECT TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR/DISPATCH
Authorized Official - Prefix:MRS
Authorized Official - First Name:KEON
Authorized Official - Middle Name:
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-607-8409
Mailing Address - Street 1:7253 S MAY ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60621-1034
Mailing Address - Country:US
Mailing Address - Phone:312-607-8409
Mailing Address - Fax:773-874-9423
Practice Address - Street 1:7253 S MAY ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60621-1034
Practice Address - Country:US
Practice Address - Phone:312-607-8409
Practice Address - Fax:773-874-9423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-24
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL7769MC343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL343667486001Medicaid