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General NPI Number Information
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NPI Number | 1770368169
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Entity Type | Organization
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Legal Business Name | ANGEL J ENTERPRISES LLC
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Dates
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Enumeration Date | 08/25/2023
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Last Update Date | 08/25/2023
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Provider Practice Location Address
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Address Line | 43 RIVES RD STE C
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City | PETERSBURG
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State | VA
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Zip | 23805-9427
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Country | US
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Telephone | 434-480-6111
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Fax |
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Provider Business Mailing Address
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Address Line | 4807 TOOLEY DR
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City | CHESTER
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State | VA
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Zip | 23831-6631
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Country | US
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Telephone | 434-480-6111
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JAQUELL WILSON
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Credential |
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Telephone | 434-480-6111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 347C00000X
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Taxonomy Name | Private Vehicle
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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 | 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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