Provider Demographics
NPI:1205539905
Name:LIVING WELL TRANSPORTATION SERVICES LLC
Entity type:Organization
Organization Name:LIVING WELL TRANSPORTATION SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANGENETTE
Authorized Official - Middle Name:YVONNE
Authorized Official - Last Name:AGAMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-608-9612
Mailing Address - Street 1:10903 WHEELER TRCE
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:GA
Mailing Address - Zip Code:30228-6461
Mailing Address - Country:US
Mailing Address - Phone:678-608-9612
Mailing Address - Fax:
Practice Address - Street 1:10903 WHEELER TRCE
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:GA
Practice Address - Zip Code:30228-6461
Practice Address - Country:US
Practice Address - Phone:678-608-9612
Practice Address - Fax:678-829-3499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-23
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)