Provider Demographics
NPI:1043976343
Name:CHARLIE'S ANGELS TRANSIT, LLC
Entity Type:Organization
Organization Name:CHARLIE'S ANGELS TRANSIT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KATRINA
Authorized Official - Middle Name:ERMAYNE
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-208-7113
Mailing Address - Street 1:667 ADDISON DR
Mailing Address - Street 2:
Mailing Address - City:WYNNE
Mailing Address - State:AR
Mailing Address - Zip Code:72396-1602
Mailing Address - Country:US
Mailing Address - Phone:870-208-7113
Mailing Address - Fax:
Practice Address - Street 1:667 ADDISON DR
Practice Address - Street 2:
Practice Address - City:WYNNE
Practice Address - State:AR
Practice Address - Zip Code:72396-1602
Practice Address - Country:US
Practice Address - Phone:870-208-7113
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-10
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)