Provider Demographics
NPI:1912548645
Name:BRITEANGEL TRANSPORTATION LLC
Entity Type:Organization
Organization Name:BRITEANGEL TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELLA
Authorized Official - Middle Name:B
Authorized Official - Last Name:JULIUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-606-2024
Mailing Address - Street 1:11317 ARISTOTLE DR APT 310
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-7494
Mailing Address - Country:US
Mailing Address - Phone:240-606-2024
Mailing Address - Fax:703-816-8515
Practice Address - Street 1:11317 ARISTOTLE DR APT 310
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-7494
Practice Address - Country:US
Practice Address - Phone:240-606-2024
Practice Address - Fax:703-816-8515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-03
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0000000Medicaid