Provider Demographics
NPI:1982979415
Name:FAMILYTREE MEDICAL TRANSPORT LLC
Entity type:Organization
Organization Name:FAMILYTREE MEDICAL TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATION MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ZOWADOE
Authorized Official - Middle Name:
Authorized Official - Last Name:MEHN
Authorized Official - Suffix:
Authorized Official - Credentials:EMS
Authorized Official - Phone:510-316-4226
Mailing Address - Street 1:PO BOX 21074
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-9074
Mailing Address - Country:US
Mailing Address - Phone:510-316-4226
Mailing Address - Fax:510-764-1120
Practice Address - Street 1:8130 NEY AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94605-3505
Practice Address - Country:US
Practice Address - Phone:510-316-4226
Practice Address - Fax:510-764-1120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-16
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA201013010156343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)