Provider Demographics
NPI:1245845783
Name:ANGELET'S NON-EMERGENCY WHEELCHAIR TRANSPORT LLC
Entity type:Organization
Organization Name:ANGELET'S NON-EMERGENCY WHEELCHAIR TRANSPORT LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:INGRID
Authorized Official - Middle Name:
Authorized Official - Last Name:BAZELAIS
Authorized Official - Suffix:
Authorized Official - Credentials:OTA11008
Authorized Official - Phone:786-859-9465
Mailing Address - Street 1:11820 MIRAMAR PKWY STE 203
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-5817
Mailing Address - Country:US
Mailing Address - Phone:545-505-7913
Mailing Address - Fax:
Practice Address - Street 1:11820 MIRAMAR PKWY STE 203
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-5817
Practice Address - Country:US
Practice Address - Phone:545-505-7913
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-11
Last Update Date:2024-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker
No341600000XTransportation ServicesAmbulance
No3416L0300XTransportation ServicesAmbulanceLand Transport
No342000000XTransportation ServicesTransportation Network Company
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL108149700Medicaid
FL1881992980Medicaid
FL109652700Medicaid