Provider Demographics
NPI:1215382502
Name:WELLNESS AMBULANCE TRANSPORT LLC
Entity Type:Organization
Organization Name:WELLNESS AMBULANCE TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ABENA
Authorized Official - Middle Name:
Authorized Official - Last Name:FYNN
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:703-597-6529
Mailing Address - Street 1:16510 BOBSTER CT
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-6316
Mailing Address - Country:US
Mailing Address - Phone:703-597-6529
Mailing Address - Fax:703-221-2415
Practice Address - Street 1:16510 BOBSTER CT
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-6316
Practice Address - Country:US
Practice Address - Phone:703-597-6529
Practice Address - Fax:703-221-2415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-25
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance