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General NPI Number Information
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NPI Number | 1730807009
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Entity Type | Organization
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Legal Business Name | FIVE NINETEEN LLC
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Dates
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Enumeration Date | 08/22/2022
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Last Update Date | 10/27/2022
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Provider Practice Location Address
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Address Line | 40801 U.S. 6 UNIT 211
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City | AVON
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State | CO
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Zip | 81620
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Country | US
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Telephone | 970-949-1111
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 9729
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City | AVON
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State | CO
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Zip | 81620-9701
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Country | US
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Telephone | 719-213-1186
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ALEGNTA HAILE YIMAM
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Credential |
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Telephone | 719-213-1186
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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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Taxonomy #2
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Taxonomy Code | 344600000X
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Taxonomy Name | Taxi
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License Number |
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License Number State |
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