Healthcare Provider Details

I. General information

NPI: 1679907505
Provider Name (Legal Business Name): JOURNEY VIA GURNEY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

Provider Other Name: JVG TRANSPORTATION

II. Dates (important events)

Enumeration Date: 08/28/2013
Last Update Date: 08/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5382 COSUMNES DR
STOCKTON CA
95219-7125
US

IV. Provider business mailing address

5382 COSUMNES DR
STOCKTON CA
95219-7125
US

V. Phone/Fax

Practice location:
  • Phone: 310-435-5006
  • Fax:
Mailing address:
  • Phone: 310-435-5006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. CHAD G HARDCASTLE
Title or Position: MANAGING MEMBER
Credential: LNHA
Phone: 310-435-5006