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General NPI Number Information
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NPI Number | 1457810921
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Entity Type | Organization
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Legal Business Name | MY BROTHERS KEEPER TRANSPORTATION LLC
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Dates
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Enumeration Date | 03/14/2019
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Last Update Date | 03/14/2019
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Provider Practice Location Address
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Address Line | 10309 KESTREL DR
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City | ASHLAND
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State | VA
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Zip | 23005-1258
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Country | US
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Telephone | 804-617-3146
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 804
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City | ASHLAND
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State | VA
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Zip | 23005-0804
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Country | US
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Telephone | 804-617-3146
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Fax |
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Authorized Official
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Title or Position | OWNER/CEO
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Name | MR. TROY ALLAN CORLEY
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Credential |
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Telephone | 804-617-3146
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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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