Healthcare Provider Details

I. General information

NPI: 1003756891
Provider Name (Legal Business Name): BLUE MOUNTAIN TRANSIT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2026
Last Update Date: 03/31/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10601 CA-88
JACKSON CA
95642
US

IV. Provider business mailing address

PO BOX 605
JACKSON CA
95642-0605
US

V. Phone/Fax

Practice location:
  • Phone: 209-223-5300
  • Fax:
Mailing address:
  • Phone: 209-223-5300
  • 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: NICOLE WOOLHEATER
Title or Position: EXECUTIVE OPERATIONS MANAGER
Credential:
Phone: 209-223-5300