=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255947057
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TAIF LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/17/2020
-----------------------------------------------------
Last Update Date | 09/17/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 209 HARDING BLVD STE 6
-----------------------------------------------------
City | ROSEVILLE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95678-2815
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-239-5408
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 209 HARDING BLVD STE 6
-----------------------------------------------------
City | ROSEVILLE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95678-2815
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-239-5408
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER-MANAGER
-----------------------------------------------------
Name | ABDULLAH ALI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 916-239-5408
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------