Provider Demographics
NPI:1891234787
Name:FAITHFUL MEDICAL TRANSPORT SERVICES LLC
Entity Type:Organization
Organization Name:FAITHFUL MEDICAL TRANSPORT SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-714-1063
Mailing Address - Street 1:18173 PIONEER BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:ARTESIA
Mailing Address - State:CA
Mailing Address - Zip Code:90701-3982
Mailing Address - Country:US
Mailing Address - Phone:562-860-8800
Mailing Address - Fax:562-366-3011
Practice Address - Street 1:17777 CENTER COURT DRIVE
Practice Address - Street 2:SUITE 600
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703
Practice Address - Country:US
Practice Address - Phone:562-714-0488
Practice Address - Fax:714-752-6083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-13
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA201703210371343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)