Healthcare Provider Details

I. General information

NPI: 1205690716
Provider Name (Legal Business Name): TAXII-4TOTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2024
Last Update Date: 02/06/2024
Certification Date: 02/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

466 PROVIDENCE RD S
WAXHAW NC
28173-8311
US

IV. Provider business mailing address

13663 PROVIDENCE RD STE 313
WEDDINGTON NC
28104-9373
US

V. Phone/Fax

Practice location:
  • Phone: 704-293-8626
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: MS. TERESHA BERRY
Title or Position: PRESIDENT
Credential:
Phone: 704-293-8626