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Charlie'S Angels Transit, LLC

Organization Active NPI PACE Provider Organization · Wynne, AR

NPI 1740946292 · NPPES record last updated Nov 9, 2021

Key facts

NPI
1740946292
Entity type
Organization (NPI type 2)
Primary specialty
PACE Provider Organization 251T00000X
Legal business name
CHARLIE'S ANGELS TRANSIT, LLC
Practice address
667 Addison Dr
Wynne, AR 72396-1602
Phone
(870) 208-7113
NPI assigned
Nov 9, 2021
Organization subpart
No

Authorized official

Name
Dr. Katrina Ermayne Harris NPI 1881358992
Title
Ceo
Phone
(870) 208-7113

Authorized official NPPES reports the authorized official by name only; the link goes to the one practitioner connected to this organization with that name.

Corporate family (same tax ID) 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

National Provider Directory

Tax ID family
Charlie'S Angels Transit LLC (2 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
PACE Provider Organization 251T00000X Yes

Addresses

Primary practice location

667 Addison Dr
Wynne, AR 72396-1602

Mailing address

667 Addison Dr
Wynne, AR 72396-1602
Phone (870) 208-7113

Other names

  • Charlie's Angels Transit, LLC Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Nov 9, 2021.

{
    "created_epoch": "1636416000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1636416000000",
    "number": "1740946292",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "667 ADDISON DR",
            "city": "WYNNE",
            "state": "AR",
            "postal_code": "723961602",
            "telephone_number": "870-208-7113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "667 ADDISON DR",
            "city": "WYNNE",
            "state": "AR",
            "postal_code": "723961602",
            "telephone_number": "870-208-7113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLIE'S ANGELS TRANSIT, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-11-09",
        "last_updated": "2021-11-09",
        "certification_date": "2021-11-09",
        "status": "A",
        "authorized_official_last_name": "HARRIS",
        "authorized_official_first_name": "KATRINA",
        "authorized_official_middle_name": "ERMAYNE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "870-208-7113",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "251T00000X",
            "taxonomy_group": "",
            "desc": "Program of All-Inclusive Care for the Elderly (PACE) Provider Organization",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Charlie's Angels Transit, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wynne, AR

All providers in Wynne, AR · PACE Provider Organization in Arkansas

Sources for this page

Verify at the official NPI Registry.