Provider Demographics
NPI:1285145854
Name:CHARIOT MEDICAL MOBILE, LLC
Entity type:Organization
Organization Name:CHARIOT MEDICAL MOBILE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DENICKA
Authorized Official - Middle Name:
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-514-9665
Mailing Address - Street 1:53211 KINGLET LN
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46637-5112
Mailing Address - Country:US
Mailing Address - Phone:574-514-9665
Mailing Address - Fax:
Practice Address - Street 1:53211 KINGLET LN
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46637-5112
Practice Address - Country:US
Practice Address - Phone:574-514-9665
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-23
Last Update Date:2017-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)