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General NPI Number Information
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NPI Number | 1790599207
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Entity Type | Organization
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Legal Business Name |
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Dates
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Enumeration Date | 02/04/2025
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Last Update Date | 02/04/2025
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Provider Practice Location Address
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Address Line | 197 LYNN DR
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City | CLAYTON
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State | NC
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Zip | 27520-4607
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Country | US
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Telephone | 919-464-6979
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 344
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City | WILSONS MILLS
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State | NC
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Zip | 27593-0344
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Country | US
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Telephone | 919-464-6979
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KEANDRE RAIFORD
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Credential |
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Telephone | 919-464-6979
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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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