Provider Demographics
NPI:1013666726
Name:SILVER WINGS SENIOR TRANSPORT LLC
Entity Type:Organization
Organization Name:SILVER WINGS SENIOR TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ETHAN
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:CASTILLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:331-998-1343
Mailing Address - Street 1:1520 WASHINGTON AVE APT 209
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63103-1866
Mailing Address - Country:US
Mailing Address - Phone:331-998-1343
Mailing Address - Fax:
Practice Address - Street 1:4147 W SANDWICH RD
Practice Address - Street 2:
Practice Address - City:SANDWICH
Practice Address - State:IL
Practice Address - Zip Code:60548-4118
Practice Address - Country:US
Practice Address - Phone:331-998-1343
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-21
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)