Organization
PREMIUM PETAL LLC
Active
Other names
Premium Petal Medical Services
Organization subpart
No
Provider details
NPI number
Authorized official
KHADIJAH MARSHALL (OWNER)
(804) 501-9127
Entity
Organization
Contact information
Practice address
13663 VAN DOREN RD, MANASSAS, VA 20112-3804
(804) 501-9127
Mailing address
13663 VAN DOREN RD, MANASSAS, VA 20112-3804
(804) 501-9127
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
—
—
343900000X
Non-emergency Medical Transport (VAN)
Primary
—
—
Other
Enumeration date
07/02/2025
Last updated
07/02/2025
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