Provider Demographics
NPI:1023516143
Name:ESSENTIAL HEALTH CARE TRANSPORT LLC
Entity type:Organization
Organization Name:ESSENTIAL HEALTH CARE TRANSPORT LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:LENARD
Authorized Official - Last Name:WASHINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-988-7596
Mailing Address - Street 1:981 N BURNT HICKORY RD STE N&O
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134-3972
Mailing Address - Country:US
Mailing Address - Phone:678-402-8880
Mailing Address - Fax:
Practice Address - Street 1:7910 GABLE DR
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-6465
Practice Address - Country:US
Practice Address - Phone:404-988-7596
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-23
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport