Provider Demographics
NPI:1396135828
Name:SILVER STAGECOACH, LLC
Entity type:Organization
Organization Name:SILVER STAGECOACH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ARRIETTA
Authorized Official - Middle Name:F
Authorized Official - Last Name:MINER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-544-7491
Mailing Address - Street 1:4155 DOW RD STE M
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32934-9256
Mailing Address - Country:US
Mailing Address - Phone:321-458-1289
Mailing Address - Fax:
Practice Address - Street 1:4155 DOW RD STE M
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32934-9256
Practice Address - Country:US
Practice Address - Phone:321-458-1289
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-05
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)