Provider Demographics
NPI:1174921274
Name:SACRED HEART MED-TRANSIT
Entity type:Organization
Organization Name:SACRED HEART MED-TRANSIT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ERIKA
Authorized Official - Middle Name:A
Authorized Official - Last Name:GLOSSON
Authorized Official - Suffix:
Authorized Official - Credentials:CSA
Authorized Official - Phone:714-833-4314
Mailing Address - Street 1:6541 FAIRLYNN BLVD
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-6414
Mailing Address - Country:US
Mailing Address - Phone:714-833-4314
Mailing Address - Fax:714-777-0247
Practice Address - Street 1:333 CITY BLVD W
Practice Address - Street 2:17TH FLOOR
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-2903
Practice Address - Country:US
Practice Address - Phone:714-833-4314
Practice Address - Fax:714-777-0247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-05
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA174067343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)