Provider Demographics
NPI:1295909703
Name:PERSONAL CARE TRANSPORTATION SERVICES LIMITED
Entity type:Organization
Organization Name:PERSONAL CARE TRANSPORTATION SERVICES LIMITED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:ETTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-966-0192
Mailing Address - Street 1:1930 E 3RD ST STE 7
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281-2977
Mailing Address - Country:US
Mailing Address - Phone:480-966-0192
Mailing Address - Fax:
Practice Address - Street 1:1930 E 3RD ST STE 7
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85281-2977
Practice Address - Country:US
Practice Address - Phone:480-966-0192
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-15
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
N/A343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ318264Medicaid