MEDICARE: BEAUTIFUL DOVE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	343800000X	Secured Medical Transport (VAN)

General Provider Information

NPI Number	:	1942166814
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEAUTIFUL DOVE LLC

Provider Business Mailing Address
First Line	:	5829 HAVEN LAKE WAY
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-5136
Country	:	US
Telephone Number	:	732-543-5472
Fax Number	:

Provider Business Practice Location Address
First Line	:	5829 HAVEN LAKE WAY
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-5136
Country	:	US
Telephone Number	:	732-543-5472
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	HANY DIMITRY
Credential	:
Telephone Number	:	732-543-5472

Provider Enumeration Date	:	01/05/2026
Last Update Date	:	03/17/2026

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Directions to “BEAUTIFUL DOVE LLC ” Practice Location

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