Provider Demographics
NPI:1144863564
Name:LITTLE ANGEL MEDICAL TRANSPORTATION LLC
Entity type:Organization
Organization Name:LITTLE ANGEL MEDICAL TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO (PRESIDENT)/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GOVINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:GURUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-444-5279
Mailing Address - Street 1:7 SHADBUSH WAY
Mailing Address - Street 2:
Mailing Address - City:WEST HENRIETTA
Mailing Address - State:NY
Mailing Address - Zip Code:14586-9432
Mailing Address - Country:US
Mailing Address - Phone:585-444-0065
Mailing Address - Fax:585-444-0126
Practice Address - Street 1:7 SHADBUSH WAY
Practice Address - Street 2:
Practice Address - City:WEST HENRIETTA
Practice Address - State:NY
Practice Address - Zip Code:14586-9432
Practice Address - Country:US
Practice Address - Phone:585-444-0065
Practice Address - Fax:585-444-0126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-18
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05566101Medicaid