Provider Demographics
NPI:1942812714
Name:SAGRADA AMBULANCE LLC
Entity Type:Organization
Organization Name:SAGRADA AMBULANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SERVICE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:
Authorized Official - Last Name:NOVELO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-988-5482
Mailing Address - Street 1:457 NATHAN DEAN BLVD # 105-99
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30132-4911
Mailing Address - Country:US
Mailing Address - Phone:789-885-4826
Mailing Address - Fax:
Practice Address - Street 1:300 W I PKWY # 203
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30132-5079
Practice Address - Country:US
Practice Address - Phone:789-885-4826
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-21
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport