Healthcare Provider Details

I. General information

NPI: 1720496201
Provider Name (Legal Business Name): JDC GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2014
Last Update Date: 11/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 ROCUS ST
SPRINGFIELD MA
01104-3258
US

IV. Provider business mailing address

PO BOX 8879
CRANSTON RI
02920-0879
US

V. Phone/Fax

Practice location:
  • Phone: 413-781-4917
  • Fax: 413-209-9161
Mailing address:
  • Phone: 401-572-3120
  • Fax: 401-572-3351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number3074
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number3074
License Number StateMA

VIII. Authorized Official

Name: MRS. CAROL A FAITA
Title or Position: MANAGER
Credential:
Phone: 413-781-4917