Provider Demographics
NPI:1356191209
Name:JEWEL TRANSPORTATION LC
Entity type:Organization
Organization Name:JEWEL TRANSPORTATION LC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:MAHMOUD
Authorized Official - Last Name:HANOUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-502-9577
Mailing Address - Street 1:14036 REDWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SHELBY TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48315-6801
Mailing Address - Country:US
Mailing Address - Phone:313-502-9577
Mailing Address - Fax:
Practice Address - Street 1:14036 REDWOOD DR
Practice Address - Street 2:
Practice Address - City:SHELBY TWP
Practice Address - State:MI
Practice Address - Zip Code:48315-6801
Practice Address - Country:US
Practice Address - Phone:313-502-9577
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-25
Last Update Date:2024-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)