Provider Demographics
NPI:1336868207
Name:C AND J TRANSPORT LEGACY LLC
Entity Type:Organization
Organization Name:C AND J TRANSPORT LEGACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CENETHIA
Authorized Official - Middle Name:LASHA
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-438-4449
Mailing Address - Street 1:295 SE RED CASON DR
Mailing Address - Street 2:
Mailing Address - City:LULU
Mailing Address - State:FL
Mailing Address - Zip Code:32061-7582
Mailing Address - Country:US
Mailing Address - Phone:386-438-4449
Mailing Address - Fax:
Practice Address - Street 1:295 SE RED CASON DR
Practice Address - Street 2:
Practice Address - City:LULU
Practice Address - State:FL
Practice Address - Zip Code:32061-7582
Practice Address - Country:US
Practice Address - Phone:386-438-4449
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)