Provider Demographics
NPI:1659620375
Name:HEALTHY NATION TRANSPORT LLC
Entity Type:Organization
Organization Name:HEALTHY NATION TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ELVENA
Authorized Official - Middle Name:Y
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-283-4862
Mailing Address - Street 1:PO BOX 3127
Mailing Address - Street 2:
Mailing Address - City:TUBA CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86045-3127
Mailing Address - Country:US
Mailing Address - Phone:928-283-4862
Mailing Address - Fax:928-283-8125
Practice Address - Street 1:4222 CACTUS LOOP DRIVE
Practice Address - Street 2:
Practice Address - City:TUBA CITY
Practice Address - State:AZ
Practice Address - Zip Code:86045
Practice Address - Country:US
Practice Address - Phone:928-283-4862
Practice Address - Fax:928-283-8125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-10
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)