Provider Demographics
NPI:1740338045
Name:MEDCARE MEDICAL TRANSPORTATION, INC
Entity type:Organization
Organization Name:MEDCARE MEDICAL TRANSPORTATION, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PAVEL
Authorized Official - Middle Name:
Authorized Official - Last Name:RASKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-505-0846
Mailing Address - Street 1:8531 LANKERSHIM BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:SUN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91352-3127
Mailing Address - Country:US
Mailing Address - Phone:818-786-4572
Mailing Address - Fax:
Practice Address - Street 1:8531 LANKERSHIM BLVD STE B
Practice Address - Street 2:
Practice Address - City:SUN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91352-3127
Practice Address - Country:US
Practice Address - Phone:818-786-4572
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMTN01053GMedicaid