Provider Demographics
NPI:1124426143
Name:CARE VAN,LLC
Entity type:Organization
Organization Name:CARE VAN,LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:IRENEO
Authorized Official - Middle Name:MASONGSONG
Authorized Official - Last Name:AGOJO
Authorized Official - Suffix:III
Authorized Official - Credentials:N/A
Authorized Official - Phone:949-547-4899
Mailing Address - Street 1:23456 MADERO STE 220
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-2771
Mailing Address - Country:US
Mailing Address - Phone:949-547-4899
Mailing Address - Fax:888-400-1134
Practice Address - Street 1:23456 MADERO STE 220
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-2771
Practice Address - Country:US
Practice Address - Phone:949-547-4899
Practice Address - Fax:888-400-1134
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARE VAN,LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-12-08
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)