Provider Demographics
NPI:1689056640
Name:AFWAJJ LLC
Entity Type:Organization
Organization Name:AFWAJJ LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EAZ ALDEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHEMD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-544-7173
Mailing Address - Street 1:2625 CASTLE ST
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-5807
Mailing Address - Country:US
Mailing Address - Phone:972-505-2727
Mailing Address - Fax:
Practice Address - Street 1:4117 N STORY RD
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038-5904
Practice Address - Country:US
Practice Address - Phone:469-544-7173
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-25
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX343800000XMedicaid