=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801558564
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BACK 2 BACK TRANSPORTATION LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/11/2021
-----------------------------------------------------
Last Update Date | 10/11/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 324 GOURD ST
-----------------------------------------------------
City | ZEBULON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27597-5537
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-702-8177
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 324 GOURD ST
-----------------------------------------------------
City | ZEBULON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27597-5537
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-702-8177
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/MANGER
-----------------------------------------------------
Name | MS. ASHLEY MONIQUE SMITH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 252-702-8177
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 146D00000X
-----------------------------------------------------
Taxonomy Name | Personal Emergency Response Attendant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------