Provider Demographics
NPI:1043736275
Name:MY SOUL TRANSPORT LLC
Entity Type:Organization
Organization Name:MY SOUL TRANSPORT LLC
Other - Org Name:N/A
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:ADJEI
Authorized Official - Suffix:
Authorized Official - Credentials:N/A
Authorized Official - Phone:571-477-8330
Mailing Address - Street 1:1512 CONSTELLATION PL APT 202
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-5218
Mailing Address - Country:US
Mailing Address - Phone:571-477-8330
Mailing Address - Fax:703-490-7250
Practice Address - Street 1:1512 CONSTELLATION PL APT 202
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-5218
Practice Address - Country:US
Practice Address - Phone:571-477-8330
Practice Address - Fax:703-490-7250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA560343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA=========OtherIRS
=========OtherIRS