Provider Demographics
NPI:1104276377
Name:JAE'S TRANSPORTAION LLC
Entity type:Organization
Organization Name:JAE'S TRANSPORTAION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:KUDLACZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-577-1337
Mailing Address - Street 1:14310 TARA ST
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83607-1431
Mailing Address - Country:US
Mailing Address - Phone:208-577-1337
Mailing Address - Fax:
Practice Address - Street 1:14310 TARA ST
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83607-1431
Practice Address - Country:US
Practice Address - Phone:208-577-1337
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-17
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDBB237706C343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)