Provider Demographics
NPI:1053961789
Name:SHUTTLE COMFORT LLC
Entity type:Organization
Organization Name:SHUTTLE COMFORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:PENDERGRASS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-362-0624
Mailing Address - Street 1:16358 JACKSON AVE
Mailing Address - Street 2:
Mailing Address - City:LEMOORE
Mailing Address - State:CA
Mailing Address - Zip Code:93245-9140
Mailing Address - Country:US
Mailing Address - Phone:559-362-0624
Mailing Address - Fax:
Practice Address - Street 1:16358 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:LEMOORE
Practice Address - State:CA
Practice Address - Zip Code:93245-9140
Practice Address - Country:US
Practice Address - Phone:559-362-0624
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-14
Last Update Date:2019-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)