Provider Demographics
NPI:1063790111
Name:XTRA CARE MEDICAL TRANSPORT, INC.
Entity type:Organization
Organization Name:XTRA CARE MEDICAL TRANSPORT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CLARISSA
Authorized Official - Middle Name:C
Authorized Official - Last Name:REDSAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-972-0311
Mailing Address - Street 1:6888 LANDRIANO PL
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91701-8521
Mailing Address - Country:US
Mailing Address - Phone:909-972-0311
Mailing Address - Fax:909-972-0304
Practice Address - Street 1:6888 LANDRIANO PL
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91701-8521
Practice Address - Country:US
Practice Address - Phone:909-972-0311
Practice Address - Fax:909-972-0304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-22
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)