=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578360178
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JALE TRANSPORTATION LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/01/2025
-----------------------------------------------------
Last Update Date | 03/01/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3739 S PACKARD AVE APT 104
-----------------------------------------------------
City | MILWAUKEE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53235-4319
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-399-5235
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3739 S PACKARD AVE APT 104
-----------------------------------------------------
City | MILWAUKEE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53235-4319
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-399-5235
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EMPLOYEE
-----------------------------------------------------
Name | MOHAMED ABDI HUSEIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 414-399-5235
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------