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General NPI Number Information
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NPI Number | 1295453702
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Entity Type | Organization
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Legal Business Name | SAFE HAVEN SENIOR TRANSPORT LLC
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Dates
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Enumeration Date | 08/19/2022
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Last Update Date | 08/30/2022
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Provider Practice Location Address
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Address Line | 1341 W MOCKINGBIRD LN SUITE 600W-#30
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City | DALLAS
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State | TX
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Zip | 75247
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Country | US
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Telephone | 972-358-7206
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Fax |
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Provider Business Mailing Address
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Address Line | 2770 BARDIN RD APT 5304
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City | GRAND PRAIRIE
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State | TX
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Zip | 75052-7300
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Country | US
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Telephone | 214-970-8794
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JAQUITA WEHRLY
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Credential |
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Telephone | 972-358-7206
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 347C00000X
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Taxonomy Name | Private Vehicle
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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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