Healthcare Provider Details

I. General information

NPI: 1164178836
Provider Name (Legal Business Name): AFTON COACH LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2022
Last Update Date: 02/22/2022
Certification Date: 02/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13740 ROCKFISH RIVER RD.
SHIPMAN VA
22971
US

IV. Provider business mailing address

13740 ROCKFISH RIVER RD.
SHIPMAN VA
22971
US

V. Phone/Fax

Practice location:
  • Phone: 434-263-7155
  • Fax:
Mailing address:
  • Phone: 434-263-7155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code344600000X
TaxonomyTaxi
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: NORMAN DANIEL
Title or Position: PRESIDENT/OWNER
Credential:
Phone: 434-263-7155