Provider Demographics
NPI:1558892000
Name:BRAVEHEART MEDICAL RESPONSE LLC
Entity Type:Organization
Organization Name:BRAVEHEART MEDICAL RESPONSE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BERNADETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-802-4700
Mailing Address - Street 1:528 FOREST PKWY STE E
Mailing Address - Street 2:
Mailing Address - City:FOREST PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30297-6109
Mailing Address - Country:US
Mailing Address - Phone:404-366-5298
Mailing Address - Fax:404-366-5299
Practice Address - Street 1:650 HILLCREST RD NW
Practice Address - Street 2:SUITE 100
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-1711
Practice Address - Country:US
Practice Address - Phone:770-802-4700
Practice Address - Fax:770-802-4702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-27
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAMB20170073416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport