Provider Demographics
NPI:1487426094
Name:CELESTIAL MEDICAL TRANSPORTATION, LLC
Entity type:Organization
Organization Name:CELESTIAL MEDICAL TRANSPORTATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DWYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-690-8404
Mailing Address - Street 1:47610 GRAND RIVER AVE # 1014
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48374-1217
Mailing Address - Country:US
Mailing Address - Phone:800-317-4371
Mailing Address - Fax:248-694-0954
Practice Address - Street 1:17200 W 10 MILE RD STE 103
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-2998
Practice Address - Country:US
Practice Address - Phone:248-557-5788
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-26
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)