=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104392661
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ABC'S OF LIFE, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/22/2018
-----------------------------------------------------
Last Update Date | 10/22/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1779 KIRBY PKWY STE 1-151
-----------------------------------------------------
City | MEMPHIS
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38138-3666
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-289-1956
-----------------------------------------------------
Fax | 901-794-2838
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1779 KIRBY PKWY STE 1-151
-----------------------------------------------------
City | MEMPHIS
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38138-3666
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-289-1956
-----------------------------------------------------
Fax | 901-794-2838
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHEIF OPERATING OFFICER
-----------------------------------------------------
Name | MR. JEREMY NATHANIEL WHITTAKER
-----------------------------------------------------
Credential | PH.D., MBA
-----------------------------------------------------
Telephone | 619-289-1956
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------