Provider Demographics
NPI:1194557462
Name:EXCEPTIONAL CARE TRANSPORTATION
Entity type:Organization
Organization Name:EXCEPTIONAL CARE TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:EDEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAGOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-309-5572
Mailing Address - Street 1:1230 S PARKER RD STE 213
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-2119
Mailing Address - Country:US
Mailing Address - Phone:619-309-5572
Mailing Address - Fax:
Practice Address - Street 1:1230 S PARKER RD STE 213
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231-2119
Practice Address - Country:US
Practice Address - Phone:619-309-5572
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-15
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)