Provider Demographics
NPI:1194583930
Name:PRESTIGE GOL-DON ANGLES TRANSPORT
Entity type:Organization
Organization Name:PRESTIGE GOL-DON ANGLES TRANSPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPANY OPERATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SYKENNA
Authorized Official - Middle Name:LAVETTE
Authorized Official - Last Name:KELLER
Authorized Official - Suffix:
Authorized Official - Credentials:CNA
Authorized Official - Phone:404-903-5925
Mailing Address - Street 1:146 CHAPEL LK S
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31419-6802
Mailing Address - Country:US
Mailing Address - Phone:404-903-5925
Mailing Address - Fax:
Practice Address - Street 1:146 CHAPEL LK S
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31419-6802
Practice Address - Country:US
Practice Address - Phone:404-903-5925
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No347C00000XTransportation ServicesPrivate Vehicle