Healthcare Provider Details

I. General information

NPI: 1659074920
Provider Name (Legal Business Name): DOG DELI LOGISTICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2023
Last Update Date: 03/26/2023
Certification Date: 03/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 PRAIRIE VIEW CT
BELMONT NC
28012-2991
US

IV. Provider business mailing address

104 PRAIRIE VIEW CT
BELMONT NC
28012-2991
US

V. Phone/Fax

Practice location:
  • Phone: 704-208-6483
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: MR. GENE MOBLEY II
Title or Position: PRESIDENT
Credential:
Phone: 704-208-6483