Provider Demographics
NPI:1255058954
Name:JAXS TRANSPORT SERVICE LLC
Entity type:Organization
Organization Name:JAXS TRANSPORT SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRENAE
Authorized Official - Middle Name:
Authorized Official - Last Name:HORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-203-4110
Mailing Address - Street 1:55 E PAULDING DR STE 122
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30157-7192
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:174 DYNASTY LN
Practice Address - Street 2:
Practice Address - City:HIRAM
Practice Address - State:GA
Practice Address - Zip Code:30141-2056
Practice Address - Country:US
Practice Address - Phone:563-203-4110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)