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General NPI Number Information
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NPI Number | 1205584026
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Entity Type | Organization
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Legal Business Name | JUST A MILE AWAY MENTAL HEALTH SERVICES INC.
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Dates
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Enumeration Date | 03/10/2022
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Last Update Date | 03/10/2022
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Provider Practice Location Address
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Address Line | 4415 W MONROE ST
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City | CHICAGO
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State | IL
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Zip | 60624-2545
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Country | US
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Telephone | 773-678-0707
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 440312
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City | CHICAGO
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State | IL
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Zip | 60644-0306
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MISS TATIANA LANE
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Credential | MBA
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Telephone | 773-678-0707
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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