Healthcare Provider Details

I. General information

NPI: 1285342253
Provider Name (Legal Business Name): ANGELS ON WHEELS TRANSPORTATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2022
Last Update Date: 11/17/2022
Certification Date: 11/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 BALSAM RD
JACKSONVILLE NC
28546-8562
US

IV. Provider business mailing address

131 BALSAM RD
JACKSONVILLE NC
28546-8562
US

V. Phone/Fax

Practice location:
  • Phone: 910-967-0374
  • Fax:
Mailing address:
  • Phone: 910-967-0374
  • 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: KILEY DONITA DAUGHTRY
Title or Position: SELF
Credential:
Phone: 910-967-0374