Provider Demographics
NPI:1407632110
Name:AGNES TRANSPORTATION LIMITED LIABILITY COMPANY
Entity Type:Organization
Organization Name:AGNES TRANSPORTATION LIMITED LIABILITY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AGNES
Authorized Official - Middle Name:
Authorized Official - Last Name:BETHELMIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-490-1563
Mailing Address - Street 1:119-22 196TH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:NY
Mailing Address - Zip Code:11412-3720
Mailing Address - Country:US
Mailing Address - Phone:718-490-1563
Mailing Address - Fax:866-466-3124
Practice Address - Street 1:20031 LINDEN BLVD
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:NY
Practice Address - Zip Code:11412-3200
Practice Address - Country:US
Practice Address - Phone:718-490-1563
Practice Address - Fax:866-466-3124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-07
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)