=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871263962
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THREE BIRDS TRANSPORTATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/20/2021
-----------------------------------------------------
Last Update Date | 09/20/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 31395 7 MILE RD STE C
-----------------------------------------------------
City | LIVONIA
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48152-4335
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-873-8935
-----------------------------------------------------
Fax | 248-482-7455
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 31395 7 MILE RD STE C
-----------------------------------------------------
City | LIVONIA
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48152-4335
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-873-8935
-----------------------------------------------------
Fax | 248-482-7455
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CO-OWNER
-----------------------------------------------------
Name | MRS. JERUSHA F NELSON-BRENT
-----------------------------------------------------
Credential | LLPC
-----------------------------------------------------
Telephone | 248-873-8935
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 342000000X
-----------------------------------------------------
Taxonomy Name | Transportation Network Company
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------