Individual provider · NPI-1

Jacob Bailey

Non-emergency Medical Transport (VAN) · Charlotte, NC

NPI number1528695301

StatusActive

Last updated in NPPESMar 24, 2020

Details

NPI: 1528695301
Entity type: Individual (NPI-1)
Name: Jacob Bailey
Sex: Male
Sole proprietor: Yes
Enumeration date: Mar 24, 2020
Certification date: Mar 24, 2020
Last updated: Mar 24, 2020

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
343900000X	Non-emergency Medical Transport (VAN)	d08570925	AZ	Yes
172A00000X	Driver	d08570925	AZ
372500000X	Chore Provider	–	–
374U00000X	Home Health Aide	–	–
376J00000X	Homemaker	–	–

Practice location

424 Plymouth Ave
Charlotte, NC 28206-3139

Phone 480-540-0111

Mailing address

424 Plymouth Ave
Charlotte, NC 28206-3139

Phone 480-540-0111

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