Provider Demographics
NPI:1811757685
Name:BROTHERLY NON-MEDICAL TRANSPORT
Entity type:Organization
Organization Name:BROTHERLY NON-MEDICAL TRANSPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORGANIZATION
Authorized Official - Prefix:
Authorized Official - First Name:VLADIMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:BENOIT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-431-7216
Mailing Address - Street 1:2095 BLACK OAK LN
Mailing Address - Street 2:
Mailing Address - City:ELLENWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30294-5511
Mailing Address - Country:US
Mailing Address - Phone:404-431-7216
Mailing Address - Fax:
Practice Address - Street 1:2095 BLACK OAK LN
Practice Address - Street 2:
Practice Address - City:ELLENWOOD
Practice Address - State:GA
Practice Address - Zip Code:30294-5511
Practice Address - Country:US
Practice Address - Phone:404-431-7216
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)