Provider Demographics
NPI:1700493079
Name:ILE AJE LLC
Entity Type:Organization
Organization Name:ILE AJE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/AGENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-513-5778
Mailing Address - Street 1:405 WESTWOOD ST APT A
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36606-6505
Mailing Address - Country:US
Mailing Address - Phone:251-513-5778
Mailing Address - Fax:
Practice Address - Street 1:405 WESTWOOD ST APT A
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36606-6505
Practice Address - Country:US
Practice Address - Phone:251-513-5778
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-30
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL300015088Medicaid