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General NPI Number Information
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NPI Number | 1841905338
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Entity Type | Organization
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Legal Business Name | JONAHS UPCOUNTRY COACH, LLC
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Dates
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Enumeration Date | 01/18/2023
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Last Update Date | 01/18/2023
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Provider Practice Location Address
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Address Line | 27065 STATE HIGHWAY 88 SPC 1
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City | PIONEER
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State | CA
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Zip | 95666-9471
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Country | US
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Telephone | 209-256-9923
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 792
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City | PIONEER
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State | CA
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Zip | 95666-0792
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Country | US
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Telephone | 209-256-9923
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Fax |
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | JOSEPH EDWARD CREASEY
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Credential |
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Telephone | 206-735-5361
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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