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General NPI Number Information
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NPI Number | 1215558747
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Entity Type | Organization
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Legal Business Name | WAYMAKER ENTERPRISES, LLC
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Dates
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Enumeration Date | 05/06/2020
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Last Update Date | 05/06/2020
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Provider Practice Location Address
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Address Line | 204 BRADFIELD RD
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City | MADISON
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State | MS
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Zip | 39110-7035
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Country | US
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Telephone | 601-940-4669
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 68071
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City | JACKSON
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State | MS
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Zip | 39286-8071
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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 | CEO
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Name | JASMINE MARTIN SMITH
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Credential | PT, DPT
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Telephone | 601-940-4669
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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Taxonomy #2
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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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