Provider Demographics
NPI:1285437996
Name:SANCTUARY PERSONAL SERVICE AGENCY
Entity type:Organization
Organization Name:SANCTUARY PERSONAL SERVICE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TAJA
Authorized Official - Middle Name:J
Authorized Official - Last Name:CALVIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-231-5013
Mailing Address - Street 1:5475 BROADWAY UNIT A286
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-1647
Mailing Address - Country:US
Mailing Address - Phone:765-409-0980
Mailing Address - Fax:
Practice Address - Street 1:1901 E 800 N
Practice Address - Street 2:
Practice Address - City:WEST LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47906-9009
Practice Address - Country:US
Practice Address - Phone:765-409-0980
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-28
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)