Provider Demographics
NPI:1649654708
Name:ADALIA MEDICAL TRANSPORT, LLC
Entity type:Organization
Organization Name:ADALIA MEDICAL TRANSPORT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEXTER
Authorized Official - Middle Name:
Authorized Official - Last Name:GILLIAM-BEALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-838-3380
Mailing Address - Street 1:1221 REDBLUFF DR
Mailing Address - Street 2:B
Mailing Address - City:WEST CARROLLTON
Mailing Address - State:OH
Mailing Address - Zip Code:45449-3198
Mailing Address - Country:US
Mailing Address - Phone:937-838-3380
Mailing Address - Fax:
Practice Address - Street 1:1221 REDBLUFF DR
Practice Address - Street 2:B
Practice Address - City:WEST CARROLLTON
Practice Address - State:OH
Practice Address - Zip Code:45449-3198
Practice Address - Country:US
Practice Address - Phone:937-838-3380
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADALIA HEALTH NETWORK, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-07-17
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSB199630343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)