Individual provider · Type 1 NPI

Telisa Long

Private Vehicle · Park Forest, IL

NPI number 1285866111 Active

Practice location

413 Indianwood Blvd
Park Forest, IL 60466-2247

Call (708) 369-2368 Map

Fax (708) 747-5980

Specialties and licenses

TaxonomyCodeLicense
Private Vehicle Primary 347C00000XL52081680690 (IL)

Private Vehicle: An individual paid to provide non-emergency transportation using their privately owned/leased vehicle.

About NPI 1285866111

Telisa Long's National Provider Identifier is 1285866111, issued on Aug 11, 2009. The primary taxonomy on file is Private Vehicle (347C00000X), and the practice location is in Park Forest, IL. The record was last updated on Aug 11, 2009.