Healthcare Provider Details

I. General information

NPI: 1659275063
Provider Name (Legal Business Name): DOUBLE LEGACY TRANSPORTATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 SCHOOL ST
ROCKFORD IL
61101-5013
US

IV. Provider business mailing address

3001 SCHOOL ST
ROCKFORD IL
61101-5013
US

V. Phone/Fax

Practice location:
  • Phone: 815-995-0711
  • Fax:
Mailing address:
  • Phone: 815-995-0711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateNULL

VIII. Authorized Official

Name: QUENTIN THOMAS
Title or Position: CEO/OWNER OPERATOR
Credential:
Phone: 815-995-0711