Provider Demographics
NPI:1093264418
Name:BLAQUE MOON ENTERPRISES LLC
Entity Type:Organization
Organization Name:BLAQUE MOON ENTERPRISES LLC
Other - Org Name:SANKOFA TRANSPORTATION SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:SHELENE
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-623-1637
Mailing Address - Street 1:PO BOX 91079
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77291-1079
Mailing Address - Country:US
Mailing Address - Phone:832-623-1637
Mailing Address - Fax:832-487-8070
Practice Address - Street 1:2025 DOLLY WRIGHT ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77088-7720
Practice Address - Country:US
Practice Address - Phone:832-623-1637
Practice Address - Fax:832-487-8070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-27
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle
No347E00000XTransportation ServicesTransportation Broker