Organization
COUNTRYWADE TRANSPORT SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SAMUEL OKONOFUA (AGENT)
(817) 637-3193
Entity
Organization
Contact information
Practice address
6028 CRESCENZIO DRIVE, GRAND PRAIRIE, TX 75052
(817) 637-3193
(817) 617-2321
Mailing address
6028 CRESCENZIO DRIVE, GRAND PRAIRIE, TX 75052
(817) 637-3193
(817) 617-2321
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
34
TX
Other
Enumeration date
08/28/2016
Last updated
10/12/2016
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