MEDICARE: REBUILDING LIFE AND EMBRACING DEATH LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	342000000X	Transportation Network Company
2	344600000X	Taxi
3	347C00000X	Private Vehicle
4	347E00000X	Transportation Broker
5	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1942977210
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REBUILDING LIFE AND EMBRACING DEATH LLC

Provider Business Mailing Address
First Line	:	PO BOX 298
Second Line	:
City	:	MOUNT VERNON
State	:	TX
Zip	:	75457-0298
Country	:	US
Telephone Number	:	870-592-0687
Fax Number	:

Provider Business Practice Location Address
First Line	:	927 N GREER BLVD
Second Line	:
City	:	PITTSBURG
State	:	TX
Zip	:	75686-1181
Country	:	US
Telephone Number	:	870-592-0687
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	LASHONDRA BROWN
Credential	:	MA, LMSW, CDP, CAGC
Telephone Number	:	870-592-0687

Provider Enumeration Date	:	08/25/2021
Last Update Date	:	08/25/2021

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