Provider Demographics
NPI:1487129896
Name:NICO CARE MEDICAL TRANSPORT, LLC
Entity type:Organization
Organization Name:NICO CARE MEDICAL TRANSPORT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:VAAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-305-1196
Mailing Address - Street 1:1311 CANTERBURY
Mailing Address - Street 2:
Mailing Address - City:HERCULES
Mailing Address - State:CA
Mailing Address - Zip Code:94547-3622
Mailing Address - Country:US
Mailing Address - Phone:415-305-1196
Mailing Address - Fax:888-828-8718
Practice Address - Street 1:1311 CANTERBURY
Practice Address - Street 2:
Practice Address - City:HERCULES
Practice Address - State:CA
Practice Address - Zip Code:94547-3622
Practice Address - Country:US
Practice Address - Phone:415-305-1196
Practice Address - Fax:888-828-8718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-11
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)