Provider Demographics
NPI:1720806458
Name:NORTHEAST WELLNESS MEDICAL TRANSPORTATION LLC
Entity type:Organization
Organization Name:NORTHEAST WELLNESS MEDICAL TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AERIANA
Authorized Official - Middle Name:MON'EY
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-369-8500
Mailing Address - Street 1:1700 POWELL ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71203-5752
Mailing Address - Country:US
Mailing Address - Phone:318-396-8500
Mailing Address - Fax:
Practice Address - Street 1:305 KIROLI RD APT 4
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-7096
Practice Address - Country:US
Practice Address - Phone:318-396-8500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-01
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)