Provider Demographics
NPI:1528840030
Name:LEGACY'S ANGEL TRANSPORTATION
Entity type:Organization
Organization Name:LEGACY'S ANGEL TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:WARDSWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-688-1952
Mailing Address - Street 1:4225 WINGREN DR STE 110
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062-2762
Mailing Address - Country:US
Mailing Address - Phone:469-688-1952
Mailing Address - Fax:
Practice Address - Street 1:4225 WINGREN DR STE 110
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-2762
Practice Address - Country:US
Practice Address - Phone:469-688-1952
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-18
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343800000XTransportation ServicesSecured Medical Transport (VAN)