Provider Demographics
NPI:1063209187
Name:LEGACY NON-EMERGENCY MEDI TRANSPORT
Entity type:Organization
Organization Name:LEGACY NON-EMERGENCY MEDI TRANSPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BEGONIA
Authorized Official - Middle Name:T
Authorized Official - Last Name:AJOSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:754-367-6256
Mailing Address - Street 1:221 E DIXIE CT APT 205
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33311-9028
Mailing Address - Country:US
Mailing Address - Phone:954-628-2626
Mailing Address - Fax:954-252-4067
Practice Address - Street 1:221 E DIXIE CT APT 205
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33311-9028
Practice Address - Country:US
Practice Address - Phone:954-628-2626
Practice Address - Fax:954-252-4067
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MAEANGELS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-04-22
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)