Healthcare Provider Details

I. General information

NPI: 1538608849
Provider Name (Legal Business Name): HEAVENLY TRANSIT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2017
Last Update Date: 02/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 FINCH DR
KATHLEEN GA
31047-3321
US

IV. Provider business mailing address

107 FINCH DR
KATHLEEN GA
31047-3321
US

V. Phone/Fax

Practice location:
  • Phone: 478-997-1381
  • Fax:
Mailing address:
  • Phone: 478-997-1381
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: CYNTHIA DENISE BILLINGSLEY
Title or Position: COO
Credential:
Phone: 478-334-9865