Provider Demographics
NPI:1750830741
Name:VIRGO LINK LLC
Entity Type:Organization
Organization Name:VIRGO LINK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:NELSON
Authorized Official - Middle Name:
Authorized Official - Last Name:NWANGANGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-616-1783
Mailing Address - Street 1:10505 PROVIDENCE DR UNIT 102
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:IA
Mailing Address - Zip Code:50131-4738
Mailing Address - Country:US
Mailing Address - Phone:804-616-1783
Mailing Address - Fax:
Practice Address - Street 1:10505 PROVIDENCE DR UNIT 102
Practice Address - Street 2:
Practice Address - City:JOHNSTON
Practice Address - State:IA
Practice Address - Zip Code:50131-4738
Practice Address - Country:US
Practice Address - Phone:804-616-1783
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-02
Last Update Date:2016-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)