Provider Demographics
NPI:1053157370
Name:JAXCARE TRANSPORTATION SERVICES LLC
Entity type:Organization
Organization Name:JAXCARE TRANSPORTATION SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESUS
Authorized Official - Middle Name:ENRIQUE
Authorized Official - Last Name:PACHECO ROMERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:754-971-5105
Mailing Address - Street 1:12220 ATLANTIC BLVD
Mailing Address - Street 2:STE 130 #1278
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12220 ATLANTIC BLVD
Practice Address - Street 2:STE 130 #1278
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225
Practice Address - Country:US
Practice Address - Phone:754-971-5105
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-05
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle