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General NPI Number Information
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NPI Number | 1891071650
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Entity Type | Organization
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Legal Business Name | WB GOOD FAITH TRANSPORTATION
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Dates
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Enumeration Date | 10/25/2011
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Last Update Date | 10/25/2011
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Provider Practice Location Address
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Address Line | 6949 S MERRILL AVE
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City | CHICAGO
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State | IL
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Zip | 60649-1728
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Country | US
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Telephone | 773-877-9665
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Fax | 773-442-0672
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Provider Business Mailing Address
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Address Line | 6949 S MERRILL AVE
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City | CHICAGO
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State | IL
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Zip | 60649-1728
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Country | US
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Telephone | 773-877-9665
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Fax | 773-442-0672
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Authorized Official
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Title or Position | TRANSPORTATION PROVIDER
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Name | MS. LATOYA BROWN
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Credential | TRANSPORTATION
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Telephone | 773-877-9665
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number | B65052483839
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License Number State | IL
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