Provider Demographics
NPI:1477246304
Name:WINGS OF LOVE OF LEESBURG TRANSPORT, LLC
Entity Type:Organization
Organization Name:WINGS OF LOVE OF LEESBURG TRANSPORT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PERNELL
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-742-2000
Mailing Address - Street 1:1014 E NORTH BLVD
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-5348
Mailing Address - Country:US
Mailing Address - Phone:352-742-2000
Mailing Address - Fax:352-360-0567
Practice Address - Street 1:1014 E NORTH BLVD
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-5348
Practice Address - Country:US
Practice Address - Phone:352-742-2000
Practice Address - Fax:352-360-0567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-26
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)