Provider Demographics
NPI:1699725143
Name:MODIVCARE SOLUTIONS, LLC
Entity type:Organization
Organization Name:MODIVCARE SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENLEAF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-888-5800
Mailing Address - Street 1:1275 PEACHTREE STREET NE
Mailing Address - Street 2:SUITE 6TH FL
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309
Mailing Address - Country:US
Mailing Address - Phone:404-888-5800
Mailing Address - Fax:877-352-5640
Practice Address - Street 1:1275 PEACHTREE STREET NE
Practice Address - Street 2:6TH FL
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309
Practice Address - Country:US
Practice Address - Phone:404-888-5800
Practice Address - Fax:877-352-5640
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MODIVCARE INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-12
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker
No341600000XTransportation ServicesAmbulance
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No344600000XTransportation ServicesTaxi
No347B00000XTransportation ServicesBus
No347C00000XTransportation ServicesPrivate Vehicle
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1521OtherELDERHEALTHTX
OK0000071637Medicaid
191815OtherAMERIGROUP
DE1000014337Medicaid
FL410187100Medicaid
GA000004686Medicaid
NV100500601OtherVARIOUS STATE AGENCIES
FL81700-035697Medicaid
PA12389OtherELDERHEALTH PA
CT061435572Medicare ID - Type UnspecifiedANTHEM BLUE CROSS BLUE SH
DE1000014337Medicaid
OK0000071637Medicaid