Provider Demographics
NPI:1922549476
Name:AGILE CARE TRANSPORTATION
Entity Type:Organization
Organization Name:AGILE CARE TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMEBER
Authorized Official - Prefix:
Authorized Official - First Name:AIMEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SULEIMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-512-5177
Mailing Address - Street 1:6203 SAN IGNACIO AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95119-1358
Mailing Address - Country:US
Mailing Address - Phone:510-512-5177
Mailing Address - Fax:
Practice Address - Street 1:6203 SAN IGNACIO AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95119-1371
Practice Address - Country:US
Practice Address - Phone:510-512-5177
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-16
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)