Organization
COACH DREAMMAKERS L.L.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RICKY BUCKLEY JR. (OWNER)
(317) 513-2386
Entity
Organization
Contact information
Practice address
5435 EMERSON WAY STE 210, INDIANAPOLIS, IN 46226-1469
(317) 758-7518
Mailing address
3136 W 21ST ST, INDIANAPOLIS, IN 46222-4802
(317) 513-2386
(317) 917-1720
Taxonomy
Speciality
Code
Description
License number
State
343800000X
Secured Medical Transport (VAN)
2330496686
IN
343900000X
Non-emergency Medical Transport (VAN)
Primary
2330496686
IN
347B00000X
Bus
2330496686
IN
Other
Enumeration date
01/17/2013
Last updated
01/17/2013
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