Provider Demographics
NPI:1013783679
Name:SIERRACARE MEDICAL TRANSPORT LLC
Entity Type:Organization
Organization Name:SIERRACARE MEDICAL TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIJAH
Authorized Official - Middle Name:
Authorized Official - Last Name:LIU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:442-423-8681
Mailing Address - Street 1:332 S ALPINE WAY UNIT B
Mailing Address - Street 2:PO BOX 8405
Mailing Address - City:BODFISH
Mailing Address - State:CA
Mailing Address - Zip Code:93205
Mailing Address - Country:US
Mailing Address - Phone:442-423-8681
Mailing Address - Fax:
Practice Address - Street 1:332 S ALPINE WAY UNIT B
Practice Address - Street 2:
Practice Address - City:BODFISH
Practice Address - State:CA
Practice Address - Zip Code:93205-8001
Practice Address - Country:US
Practice Address - Phone:442-423-8681
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle