Provider Demographics
NPI:1215522107
Name:SENIOR PARADISE TRANSPORTATION
Entity type:Organization
Organization Name:SENIOR PARADISE TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DRIVER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:DARCY
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-333-0654
Mailing Address - Street 1:757 SW SARAZEN AVE
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-3762
Mailing Address - Country:US
Mailing Address - Phone:954-812-5105
Mailing Address - Fax:
Practice Address - Street 1:3650 SW VICEROY ST
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-3733
Practice Address - Country:US
Practice Address - Phone:772-333-0654
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-03
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)