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General NPI Number Information
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NPI Number | 1255728804
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Entity Type | Organization
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Legal Business Name | HEAVENS DOOR TRANSPORTATION LLC
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Dates
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Enumeration Date | 04/22/2015
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Last Update Date | 10/05/2021
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Provider Practice Location Address
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Address Line | 133 OLD RIVER BRIDGE RD SE
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City | MILLEDGEVILLE
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State | GA
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Zip | 31061-7985
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Country | US
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Telephone | 478-456-2210
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Fax |
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Provider Business Mailing Address
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Address Line | 133 OLD RIVER BRIDGE RD SE
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City | MILLEDGEVILLE
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State | GA
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Zip | 31061-7985
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Country | US
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Telephone | 478-456-2210
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. TIMOTHY J MADDOX
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Credential |
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Telephone | 478-456-2210
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 374T00000X
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Taxonomy Name | Religious Nonmedical Nursing Personnel
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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