=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265296503
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CAMILLE'S ANGELS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/07/2024
-----------------------------------------------------
Last Update Date | 02/07/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1633 GUTHRIE ST
-----------------------------------------------------
City | VIRGINIA BEACH
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23464-6706
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-629-4421
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1633 GUTHRIE ST
-----------------------------------------------------
City | VA BEACH
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23464-6706
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-228-4301
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. MICHAEL FRASIER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 747-228-4301
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------