Provider Demographics
NPI:1841905338
Name:JONAHS UPCOUNTRY COACH, LLC
Entity type:Organization
Organization Name:JONAHS UPCOUNTRY COACH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:CREASEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-735-5361
Mailing Address - Street 1:PO BOX 792
Mailing Address - Street 2:
Mailing Address - City:PIONEER
Mailing Address - State:CA
Mailing Address - Zip Code:95666-0792
Mailing Address - Country:US
Mailing Address - Phone:209-256-9923
Mailing Address - Fax:
Practice Address - Street 1:27065 STATE HIGHWAY 88 SPC 1
Practice Address - Street 2:
Practice Address - City:PIONEER
Practice Address - State:CA
Practice Address - Zip Code:95666-9471
Practice Address - Country:US
Practice Address - Phone:209-256-9923
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-18
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi