Provider Demographics
NPI:1013187244
Name:CJ CRITICAL CARE TRANSPORTATION SYSTEMS OF KY INC
Entity Type:Organization
Organization Name:CJ CRITICAL CARE TRANSPORTATION SYSTEMS OF KY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NATIONAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:KEENE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-915-2301
Mailing Address - Street 1:621 CARNEGIE DR
Mailing Address - Street 2:STE 205
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-3536
Mailing Address - Country:US
Mailing Address - Phone:800-499-9495
Mailing Address - Fax:
Practice Address - Street 1:2807 TAYLORSVILLE RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-3166
Practice Address - Country:US
Practice Address - Phone:502-479-9105
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CJ CRITICAL CARE TRANSPORTATION SYSTEMS OF KY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-04
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY70013416A0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416A0800XTransportation ServicesAmbulanceAir Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY55001630Medicaid
KY55001630Medicaid