Healthcare Provider Details

I. General information

NPI: 1083423883
Provider Name (Legal Business Name): ASSURED QUALITY TRANSPORTATION AND CLIENT SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2025
Last Update Date: 01/06/2025
Certification Date: 01/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5720 PRESENTATION ST
KNIGHTDALE NC
27545-7415
US

IV. Provider business mailing address

5720 PRESENTATION ST
KNIGHTDALE NC
27545-7415
US

V. Phone/Fax

Practice location:
  • Phone: 919-616-1216
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code347B00000X
TaxonomyBus
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number State

VIII. Authorized Official

Name: JESSICA BLACKMAN
Title or Position: ADMINISTRATOR
Credential:
Phone: 919-616-1216