Provider Demographics
NPI:1043909385
Name:BLACK DIAMOND TRANSPORTATION LLC
Entity Type:Organization
Organization Name:BLACK DIAMOND TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:R
Authorized Official - Last Name:PRATER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:276-210-3320
Mailing Address - Street 1:226 ROCKBRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:RICHLANDS
Mailing Address - State:VA
Mailing Address - Zip Code:24641-2247
Mailing Address - Country:US
Mailing Address - Phone:276-210-3320
Mailing Address - Fax:
Practice Address - Street 1:226 ROCKBRIDGE AVE
Practice Address - Street 2:
Practice Address - City:RICHLANDS
Practice Address - State:VA
Practice Address - Zip Code:24641-2247
Practice Address - Country:US
Practice Address - Phone:276-210-3320
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-03
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi