Provider Demographics
NPI:1134632425
Name:PERSEVERANCE EXCELLENCE COURAGE COMMUNITY MEDICAL TRAN.SERVICE LLC
Entity type:Organization
Organization Name:PERSEVERANCE EXCELLENCE COURAGE COMMUNITY MEDICAL TRAN.SERVICE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANIKA
Authorized Official - Middle Name:GENISE
Authorized Official - Last Name:SLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-684-9050
Mailing Address - Street 1:3836 CHINKAPIN ST
Mailing Address - Street 2:
Mailing Address - City:HARVEY
Mailing Address - State:LA
Mailing Address - Zip Code:70058-2021
Mailing Address - Country:US
Mailing Address - Phone:504-684-9050
Mailing Address - Fax:504-348-3967
Practice Address - Street 1:3836 CHINKAPIN ST
Practice Address - Street 2:
Practice Address - City:HARVEY
Practice Address - State:LA
Practice Address - Zip Code:70058-2021
Practice Address - Country:US
Practice Address - Phone:504-684-9050
Practice Address - Fax:504-348-3967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-09
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)