Provider Demographics
NPI:1972361392
Name:JAYTRUST LLC
Entity type:Organization
Organization Name:JAYTRUST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MALIEKE
Authorized Official - Middle Name:BENJAMIN
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:773-574-8679
Mailing Address - Street 1:408 BENSLEY AVE
Mailing Address - Street 2:
Mailing Address - City:CALUMET CITY
Mailing Address - State:IL
Mailing Address - Zip Code:60409-2390
Mailing Address - Country:US
Mailing Address - Phone:773-574-8679
Mailing Address - Fax:
Practice Address - Street 1:408 BENSLEY AVE
Practice Address - Street 2:
Practice Address - City:CALUMET CITY
Practice Address - State:IL
Practice Address - Zip Code:60409-2390
Practice Address - Country:US
Practice Address - Phone:773-574-8679
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)