Healthcare Provider Details

I. General information

NPI: 1164332458
Provider Name (Legal Business Name): EXECUTIVE NEMT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 S REAL RD
BAKERSFIELD CA
93309-2135
US

IV. Provider business mailing address

3512 COLLINGWOOD DR
BAKERSFIELD CA
93311-8756
US

V. Phone/Fax

Practice location:
  • Phone: 661-808-5303
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER BAKER
Title or Position: MANAGING MEMBER
Credential:
Phone: 661-304-5234