Provider Demographics
NPI:1215612486
Name:N A WELLNESS TRANSPORTATION
Entity type:Organization
Organization Name:N A WELLNESS TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:EBOLUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-803-8636
Mailing Address - Street 1:4405 GENESIS CT
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-8667
Mailing Address - Country:US
Mailing Address - Phone:469-803-8636
Mailing Address - Fax:
Practice Address - Street 1:4405 GENESIS CT
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-8667
Practice Address - Country:US
Practice Address - Phone:469-803-8636
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-16
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343800000XTransportation ServicesSecured Medical Transport (VAN)