Provider Demographics
NPI:1164047650
Name:ANGELS TOUCH ELITE TRANSPORTATION
Entity Type:Organization
Organization Name:ANGELS TOUCH ELITE TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:ELIJAH
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:386-292-9265
Mailing Address - Street 1:100 COURT ST SE STE 212
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:FL
Mailing Address - Zip Code:32064-3203
Mailing Address - Country:US
Mailing Address - Phone:386-209-7649
Mailing Address - Fax:386-362-1163
Practice Address - Street 1:100 COURT ST SE STE 212
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:FL
Practice Address - Zip Code:32064-3203
Practice Address - Country:US
Practice Address - Phone:386-209-7649
Practice Address - Fax:386-362-1163
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANGELS TOUCH COMPANION CARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-06-10
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No347C00000XTransportation ServicesPrivate Vehicle
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL105724200Medicaid