Individual
JACOB BAILEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
424 PLYMOUTH AVE, CHARLOTTE, NC 28206-3139
(480) 540-0111
Mailing address
424 PLYMOUTH AVE, CHARLOTTE, NC 28206-3139
(480) 540-0111
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
D08570925
AZ
343900000X
Non-emergency Medical Transport (VAN)
Primary
D08570925
AZ
372500000X
Chore Provider
—
—
374U00000X
Home Health Aide
—
—
376J00000X
Homemaker
—
—
Other
Enumeration date
03/24/2020
Last updated
03/24/2020
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