Provider Demographics
NPI:1578098133
Name:HEAVENLY EXPRESS NON-EMERGENCY TRANSPORTATION
Entity Type:Organization
Organization Name:HEAVENLY EXPRESS NON-EMERGENCY TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CHERMIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCMILLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-361-9205
Mailing Address - Street 1:8042 IRENE BLVD
Mailing Address - Street 2:101
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38125-3848
Mailing Address - Country:US
Mailing Address - Phone:901-361-9205
Mailing Address - Fax:
Practice Address - Street 1:8042 IRENE BLVD
Practice Address - Street 2:101
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38125-3848
Practice Address - Country:US
Practice Address - Phone:901-361-9205
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-20
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)