# BRAVEHEART MEDICAL RESPONSE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1558892000
- **Authorized official:** BERNADETTE MOORE (PRESIDENT)
- **Authorized official phone:** (770) 802-4700

## Contact information

- **Practice address:** 650 HILLCREST RD NW, SUITE 100, LILBURN, GA 30047-1711
- **Practice address phone:** (770) 802-4700
- **Practice address fax:** (770) 802-4702
- **Mailing address:** 528 FOREST PKWY STE E, FOREST PARK, GA 30297-6109
- **Mailing address phone:** (404) 366-5298
- **Mailing address fax:** (404) 366-5299

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3416L0300X | Land Ambulance | AMB2017007 | GA | Yes |

## Other

- **Enumeration date:** 03/27/2017
- **Last updated:** 10/28/2019