Healthcare Provider Details

I. General information

NPI: 1205615838
Provider Name (Legal Business Name): URBAN IMPACT PROJECT MA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2023
Last Update Date: 09/25/2023
Certification Date: 09/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

276 BRIDGE ST STE 305
SPRINGFIELD MA
01103-1410
US

IV. Provider business mailing address

276 BRIDGE ST STE 305
SPRINGFIELD MA
01103-1410
US

V. Phone/Fax

Practice location:
  • Phone: 413-331-9355
  • Fax:
Mailing address:
  • Phone: 413-331-9355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code344600000X
TaxonomyTaxi
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number State

VIII. Authorized Official

Name: JYNAI MCDONALD
Title or Position: CEO
Credential:
Phone: 413-331-9355