Provider Demographics
NPI:1700371879
Name:JR HANDICAP TRANSPORT, LLC
Entity Type:Organization
Organization Name:JR HANDICAP TRANSPORT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNENE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-820-5073
Mailing Address - Street 1:425 BERNINI AVE
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-2369
Mailing Address - Country:US
Mailing Address - Phone:520-820-5073
Mailing Address - Fax:
Practice Address - Street 1:425 BERNINI AVE
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-2369
Practice Address - Country:US
Practice Address - Phone:520-820-5073
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-29
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)