Provider Demographics
NPI:1780458729
Name:GOLDEN WINGS TRANSPORTATION LLC
Entity type:Organization
Organization Name:GOLDEN WINGS TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIK
Authorized Official - Middle Name:
Authorized Official - Last Name:LIPSCOMB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-419-9829
Mailing Address - Street 1:434 GANTTS GROVE CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:MOORESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28114-9612
Mailing Address - Country:US
Mailing Address - Phone:704-419-9829
Mailing Address - Fax:
Practice Address - Street 1:434 GANTTS GROVE CHURCH RD
Practice Address - Street 2:
Practice Address - City:MOORESBORO
Practice Address - State:NC
Practice Address - Zip Code:28114-9612
Practice Address - Country:US
Practice Address - Phone:704-419-9829
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-09
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)