Provider Demographics
NPI:1396437265
Name:SIERRA EXPRESS MEDICAL DELIVERY LLC
Entity type:Organization
Organization Name:SIERRA EXPRESS MEDICAL DELIVERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:JOSEPH KEH
Authorized Official - Last Name:YILLAH
Authorized Official - Suffix:
Authorized Official - Credentials:BA,MA
Authorized Official - Phone:571-477-6774
Mailing Address - Street 1:57 TUPELO ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-5654
Mailing Address - Country:US
Mailing Address - Phone:857-777-8704
Mailing Address - Fax:
Practice Address - Street 1:57 TUPELO ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-5654
Practice Address - Country:US
Practice Address - Phone:857-777-8704
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes347E00000XTransportation ServicesTransportation Broker
No171WV0202XOther Service ProvidersContractorVehicle ModificationsGroup - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Single Specialty
No171W00000XOther Service ProvidersContractorGroup - Single Specialty