Provider Demographics
NPI:1972146124
Name:EASTERN SOURCE SOLUTIONS LLC
Entity type:Organization
Organization Name:EASTERN SOURCE SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:E
Authorized Official - Last Name:ROSABAL PADRON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-202-2160
Mailing Address - Street 1:10471 6 MILE CYPRESS PKWY STE 400
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33966-6973
Mailing Address - Country:US
Mailing Address - Phone:239-202-2160
Mailing Address - Fax:
Practice Address - Street 1:10471 6 MILE CYPRESS PKWY STE 400
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33966-6973
Practice Address - Country:US
Practice Address - Phone:239-202-2160
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-21
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes347E00000XTransportation ServicesTransportation Broker
No172A00000XOther Service ProvidersDriverGroup - Multi-Specialty
No343800000XTransportation ServicesSecured Medical Transport (VAN)
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate VehicleGroup - Multi-Specialty