Healthcare Provider Details

I. General information

NPI: 1306700638
Provider Name (Legal Business Name): ERTA ALE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1517 AINSLIE PLACE RD
INDIAN TRAIL NC
28079-5836
US

IV. Provider business mailing address

1517 AINSLIE PLACE RD
INDIAN TRAIL NC
28079-5836
US

V. Phone/Fax

Practice location:
  • Phone: 404-246-6483
  • Fax:
Mailing address:
  • Phone: 404-246-6483
  • 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: HAILEYESUS FENTA
Title or Position: OWNER/MANAGER/DRIVER
Credential:
Phone: 404-246-6483