Healthcare Provider Details

I. General information

NPI: 1417791104
Provider Name (Legal Business Name): I & I COACH SERVICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2024
Last Update Date: 07/03/2024
Certification Date: 07/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 PARK AVE E
MANSFIELD OH
44902-1830
US

IV. Provider business mailing address

140 PARK AVE E
MANSFIELD OH
44902-1830
US

V. Phone/Fax

Practice location:
  • Phone: 862-222-1188
  • Fax:
Mailing address:
  • Phone: 862-222-1188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code342000000X
TaxonomyTransportation Network Company
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: ISAAC DAVID
Title or Position: OWNER
Credential: CDCA
Phone: 862-222-1188