Provider Demographics
NPI:1609569821
Name:JENNINGS WEST PAC
Entity Type:Organization
Organization Name:JENNINGS WEST PAC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOYLE
Authorized Official - Middle Name:LESHUNE
Authorized Official - Last Name:JENNINGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-379-3603
Mailing Address - Street 1:PO BOX 90924
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92427-1924
Mailing Address - Country:US
Mailing Address - Phone:909-379-3603
Mailing Address - Fax:
Practice Address - Street 1:26135 BASELINE ST SPC 25
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:CA
Practice Address - Zip Code:92346-2842
Practice Address - Country:US
Practice Address - Phone:909-379-3603
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-01
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)