Provider Demographics
NPI:1073037974
Name:HEAVENLY ANGELS TRANSPORTATION LLC
Entity Type:Organization
Organization Name:HEAVENLY ANGELS TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DUWAYNE
Authorized Official - Middle Name:JUSTIN
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-470-7775
Mailing Address - Street 1:2712 SHANNON DR
Mailing Address - Street 2:
Mailing Address - City:VIOLET
Mailing Address - State:LA
Mailing Address - Zip Code:70092-2873
Mailing Address - Country:US
Mailing Address - Phone:504-470-7775
Mailing Address - Fax:
Practice Address - Street 1:2712 SHANNON DR
Practice Address - Street 2:
Practice Address - City:VIOLET
Practice Address - State:LA
Practice Address - Zip Code:70092
Practice Address - Country:US
Practice Address - Phone:504-470-7775
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA008589784343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)