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General NPI Number Information
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NPI Number | 1578834826
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Entity Type | Organization
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Legal Business Name | JACKSONTOWN ROAD, LLC
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Dates
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Enumeration Date | 01/18/2012
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Last Update Date | 11/18/2015
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Provider Practice Location Address
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Address Line | 1724 1ST ST NW
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City | WASHINGTON
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State | DC
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Zip | 20001-1138
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Country | US
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Telephone | 202-642-9370
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Fax | 202-459-2208
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Provider Business Mailing Address
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Address Line | 828 S DINWIDDIE ST
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City | ARLINGTON
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State | VA
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Zip | 22204-2912
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Country | US
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Telephone | 202-642-9370
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MRS. LISA W HAYES
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Credential |
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Telephone | 202-642-9370
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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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