| NPI | 1568191815 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICKY JACKSON Owner 754-264-8521 |
| Organization Subpart ? | No |
| Primary Taxonomy | 343900000X Non-emergency Medical Transport (VAN) |
| Additional Taxonomies | 347C00000X Private Vehicle |
| Enumeration Date | 2022-06-09 |
| Last Update Date | 2022-11-09 |