Healthcare Provider Details

I. General information

NPI: 1922514686
Provider Name (Legal Business Name): JJDAC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2017
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 W MALONEY AVE
GALLUP NM
87301
US

IV. Provider business mailing address

PO BOX 56141
LOS ANGELES CA
90074-6141
US

V. Phone/Fax

Practice location:
  • Phone: 505-722-7746
  • Fax:
Mailing address:
  • Phone: 800-913-9106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: TIMOTHY JOSEPH DORN
Title or Position: CHIEF ADMINISTRATIVE OFFICER
Credential:
Phone: 833-703-2294