Healthcare Provider Details

I. General information

NPI: 1578476271
Provider Name (Legal Business Name): TBD ROUTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9719 LINCOLN VILLAGE DR STE 504
SACRAMENTO CA
95827-3332
US

IV. Provider business mailing address

9719 LINCOLN VILLAGE DR STE 504
SACRAMENTO CA
95827-3332
US

V. Phone/Fax

Practice location:
  • Phone: 916-410-4903
  • Fax:
Mailing address:
  • Phone: 916-410-4903
  • 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: TOJ B DAVIS
Title or Position: OWNER
Credential:
Phone: 916-410-4903