Provider Demographics
NPI:1053901538
Name:HEAVENLY TRANSPORTATION & SERVICES
Entity type:Organization
Organization Name:HEAVENLY TRANSPORTATION & SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:TAMARA
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-797-0382
Mailing Address - Street 1:5827 TREASURE COVE RD
Mailing Address - Street 2:
Mailing Address - City:COVE
Mailing Address - State:TX
Mailing Address - Zip Code:77523-1508
Mailing Address - Country:US
Mailing Address - Phone:786-797-0382
Mailing Address - Fax:
Practice Address - Street 1:5827 TREASURE COVE RD
Practice Address - Street 2:
Practice Address - City:COVE
Practice Address - State:TX
Practice Address - Zip Code:77523-1508
Practice Address - Country:US
Practice Address - Phone:786-797-0382
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-19
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No174200000XOther Service ProvidersMeals
No347C00000XTransportation ServicesPrivate Vehicle