Provider Demographics
NPI:1386327989
Name:BRAGGS TRANSPORTATION LLC
Entity type:Organization
Organization Name:BRAGGS TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDRE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAGG
Authorized Official - Suffix:SR
Authorized Official - Credentials:VANLIFT DRIVER
Authorized Official - Phone:209-403-9351
Mailing Address - Street 1:4215 N PERSHING AVE APT 19
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-6941
Mailing Address - Country:US
Mailing Address - Phone:209-403-9351
Mailing Address - Fax:
Practice Address - Street 1:4215 N PERSHING AVE APT 19
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-6941
Practice Address - Country:US
Practice Address - Phone:209-403-9351
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-09
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)