Provider Demographics
NPI:1366014045
Name:ANGELIC TRANSPORT SERVICE, LLC
Entity Type:Organization
Organization Name:ANGELIC TRANSPORT SERVICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROSHEEMA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAISEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-698-3416
Mailing Address - Street 1:1227 16TH AVE # 333
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29526-3483
Mailing Address - Country:US
Mailing Address - Phone:843-698-3416
Mailing Address - Fax:
Practice Address - Street 1:1804 GEMINI CIR
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29527-4035
Practice Address - Country:US
Practice Address - Phone:843-698-3416
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-13
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)