Provider Demographics
NPI:1932726437
Name:NOVA LIFE LONG TRANSPORTATION
Entity Type:Organization
Organization Name:NOVA LIFE LONG TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDRA
Authorized Official - Middle Name:JENINA
Authorized Official - Last Name:SEIDEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-358-6800
Mailing Address - Street 1:7400 ENGLEWOOD PL APT 2
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-2733
Mailing Address - Country:US
Mailing Address - Phone:484-358-6800
Mailing Address - Fax:
Practice Address - Street 1:7400 ENGLEWOOD PL APT 2
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-2733
Practice Address - Country:US
Practice Address - Phone:484-358-6800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-30
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)