Provider Demographics
NPI:1104947944
Name:ADVANCED CARE TRANSPORT, LLC
Entity type:Organization
Organization Name:ADVANCED CARE TRANSPORT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KORI
Authorized Official - Middle Name:A
Authorized Official - Last Name:DONOVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-936-9142
Mailing Address - Street 1:19341 LINCOLN HWY
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:IN
Mailing Address - Zip Code:46563-8060
Mailing Address - Country:US
Mailing Address - Phone:574-936-9142
Mailing Address - Fax:574-936-9187
Practice Address - Street 1:19341 LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:IN
Practice Address - Zip Code:46563-8060
Practice Address - Country:US
Practice Address - Phone:574-936-9142
Practice Address - Fax:574-936-9187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN54674343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)