Provider Demographics
NPI:1194140350
Name:GOOD SHEPHERD TRANSPORT LLC
Entity type:Organization
Organization Name:GOOD SHEPHERD TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ARLENE
Authorized Official - Middle Name:MINA
Authorized Official - Last Name:AQUINO-MOOTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-470-3425
Mailing Address - Street 1:27713 IRIS CT
Mailing Address - Street 2:
Mailing Address - City:CANYON COUNTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91351-3448
Mailing Address - Country:US
Mailing Address - Phone:661-424-1646
Mailing Address - Fax:
Practice Address - Street 1:27713 IRIS CT
Practice Address - Street 2:
Practice Address - City:CANYON COUNTRY
Practice Address - State:CA
Practice Address - Zip Code:91351-3448
Practice Address - Country:US
Practice Address - Phone:661-424-1646
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-25
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)