Healthcare Provider Details

I. General information

NPI: 1396437265
Provider Name (Legal Business Name): SIERRA EXPRESS MEDICAL DELIVERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2023
Last Update Date: 05/22/2023
Certification Date: 05/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 TUPELO ST
BROCKTON MA
02301-5654
US

IV. Provider business mailing address

57 TUPELO ST
BROCKTON MA
02301-5654
US

V. Phone/Fax

Practice location:
  • Phone: 857-777-8704
  • Fax:
Mailing address:
  • Phone: 857-777-8704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code171WV0202X
TaxonomyVehicle Modifications Contractor
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number State

VIII. Authorized Official

Name: MR. EMMANUEL JOSEPH KEH YILLAH
Title or Position: CEO
Credential: BA,MA
Phone: 571-477-6774