Provider Demographics
NPI:1932642717
Name:CONNECTED CARE TRANSPORT INC
Entity Type:Organization
Organization Name:CONNECTED CARE TRANSPORT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:QUAVISA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:855-255-7337
Mailing Address - Street 1:5865 RIDGEWAY CENTER PKWY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-4032
Mailing Address - Country:US
Mailing Address - Phone:855-255-7337
Mailing Address - Fax:855-255-7337
Practice Address - Street 1:5865 RIDGEWAY CENTER PKWY
Practice Address - Street 2:SUITE 300
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-4032
Practice Address - Country:US
Practice Address - Phone:855-255-7337
Practice Address - Fax:855-255-7337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-28
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN090776142343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)