=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326859372
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CARELINK MEDICAL TRANSPORT AND COMPANIONSHIP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/17/2025
-----------------------------------------------------
Last Update Date | 01/17/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11852 CHERRY BARK DR W
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32218-5088
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-684-5519
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11852 CHERRY BARK DR W
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32218-5088
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-684-5519
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | KEWANNA POOLE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 904-684-5519
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 320900000X
-----------------------------------------------------
Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------