Healthcare Provider Details

I. General information

NPI: 1366350555
Provider Name (Legal Business Name): HAVILAH MEDICAL TRANSPORTATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16020 CROSSED TALONS RD
WOODBRIDGE VA
22193-5797
US

IV. Provider business mailing address

3057 NUTLEY ST STE 105
FAIRFAX VA
22031-1931
US

V. Phone/Fax

Practice location:
  • Phone: 202-438-5271
  • Fax:
Mailing address:
  • Phone: 202-438-5271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL RICHARDSON
Title or Position: OWNER
Credential:
Phone: 202-438-5271