Provider Demographics
NPI:1851757223
Name:GOD BLESSED MEDICAL CARE TRANSP, LLC
Entity Type:Organization
Organization Name:GOD BLESSED MEDICAL CARE TRANSP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LEGESSE
Authorized Official - Middle Name:LEMMA
Authorized Official - Last Name:HAILE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-267-9993
Mailing Address - Street 1:821 MADISON ST
Mailing Address - Street 2:APT #101
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314
Mailing Address - Country:US
Mailing Address - Phone:571-267-9993
Mailing Address - Fax:
Practice Address - Street 1:821 MADISON ST
Practice Address - Street 2:APT #101
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314
Practice Address - Country:US
Practice Address - Phone:571-267-9993
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-14
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)