Provider Demographics
NPI:1154422368
Name:DIRECT LINE
Entity type:Organization
Organization Name:DIRECT LINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:P
Authorized Official - Last Name:TENAZAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-727-0403
Mailing Address - Street 1:4949 DILLON CROSS WAY
Mailing Address - Street 2:
Mailing Address - City:ANTELOPE
Mailing Address - State:CA
Mailing Address - Zip Code:95843-5617
Mailing Address - Country:US
Mailing Address - Phone:916-727-0403
Mailing Address - Fax:916-727-1541
Practice Address - Street 1:4949 DILLON CROSS WAY
Practice Address - Street 2:
Practice Address - City:ANTELOPE
Practice Address - State:CA
Practice Address - Zip Code:95843-5617
Practice Address - Country:US
Practice Address - Phone:916-727-0403
Practice Address - Fax:916-727-1541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA304410343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)