Provider Demographics
NPI:1558997650
Name:GEO SPIRIT, LLC
Entity Type:Organization
Organization Name:GEO SPIRIT, LLC
Other - Org Name:GEO SPIRIT, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:KHORGUASHVILI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-339-4243
Mailing Address - Street 1:1044 PORTE HARBOUR ARCH APT 202
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23664-1556
Mailing Address - Country:US
Mailing Address - Phone:757-339-4243
Mailing Address - Fax:
Practice Address - Street 1:2413 TANNING REEVE WAY
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23453-5563
Practice Address - Country:US
Practice Address - Phone:757-339-4243
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-20
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)