Provider Demographics
NPI:1063228542
Name:AVID CARE TRANSPORT LLC
Entity type:Organization
Organization Name:AVID CARE TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:USAMAH
Authorized Official - Middle Name:
Authorized Official - Last Name:KHALIFAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-643-3737
Mailing Address - Street 1:8101 BOAT CLUB RD STE 240 PMB # 3148
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76179
Mailing Address - Country:US
Mailing Address - Phone:682-200-3891
Mailing Address - Fax:
Practice Address - Street 1:20570 MORRIS AVE
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44123-2910
Practice Address - Country:US
Practice Address - Phone:682-200-3891
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-09
Last Update Date:2025-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343800000XTransportation ServicesSecured Medical Transport (VAN)
No251X00000XAgenciesSupports Brokerage
No342000000XTransportation ServicesTransportation Network Company
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle