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General NPI Number Information
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NPI Number | 1043736275
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Entity Type | Organization
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Legal Business Name | MY SOUL TRANSPORT LLC
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Dates
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Enumeration Date | 08/18/2017
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Last Update Date | 10/01/2024
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Provider Practice Location Address
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Address Line | 1512 CONSTELLATION PL APT 202
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City | WOODBRIDGE
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State | VA
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Zip | 22191-5218
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Country | US
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Telephone | 571-477-8330
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Fax | 703-490-7250
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Provider Business Mailing Address
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Address Line | 1512 CONSTELLATION PL APT 202
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City | WOODBRIDGE
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State | VA
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Zip | 22191-5218
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Country | US
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Telephone | 571-477-8330
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Fax | 703-490-7250
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Authorized Official
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Title or Position | OWNER
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Name | MR. PAUL ADJEI
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Credential | N/A
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Telephone | 571-477-8330
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number | 560
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License Number State | VA
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