Provider Demographics
NPI:1114515368
Name:YOUR ANGEL TRANSPORTATION
Entity Type:Organization
Organization Name:YOUR ANGEL TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATRYNA
Authorized Official - Middle Name:H
Authorized Official - Last Name:THEODORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-258-3540
Mailing Address - Street 1:3813 LAKE PROVIDENCE DR
Mailing Address - Street 2:
Mailing Address - City:HARVEY
Mailing Address - State:LA
Mailing Address - Zip Code:70058-5180
Mailing Address - Country:US
Mailing Address - Phone:504-258-3540
Mailing Address - Fax:504-391-9896
Practice Address - Street 1:3813 LAKE PROVIDENCE DR
Practice Address - Street 2:
Practice Address - City:HARVEY
Practice Address - State:LA
Practice Address - Zip Code:70058-5180
Practice Address - Country:US
Practice Address - Phone:504-258-3540
Practice Address - Fax:504-391-9896
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:YOUR ANGEL TRANSPORTATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-01-04
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)