Provider Demographics
NPI:1154806453
Name:ANGELS ON WHEELZ TRANSPORTATION LLC
Entity type:Organization
Organization Name:ANGELS ON WHEELZ TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARMAINE
Authorized Official - Middle Name:S
Authorized Official - Last Name:NIX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-278-0057
Mailing Address - Street 1:27801 EUCLID AVE STE 5605
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44132-3555
Mailing Address - Country:US
Mailing Address - Phone:440-278-0057
Mailing Address - Fax:440-860-4076
Practice Address - Street 1:27801 EUCLID AVE STE 5605
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44132-3555
Practice Address - Country:US
Practice Address - Phone:440-278-0057
Practice Address - Fax:440-860-4076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-02
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0Medicaid