=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699414045
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VIBE2GO TRANSPORTATION SERVICE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/02/2022
-----------------------------------------------------
Last Update Date | 06/23/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 40 PEACHTREE VALLEY RD NE APT 2721
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30309-8019
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-270-2757
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 40 PEACHTREE VALLEY RD NE APT 2721
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30309-8019
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 470-799-9298
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | KAELYN SIMS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 678-270-2757
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------