Provider Demographics
NPI:1205400892
Name:MAHOGANY TRANSPORTATION
Entity Type:Organization
Organization Name:MAHOGANY TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMARA
Authorized Official - Middle Name:MCCLENDON
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-281-3597
Mailing Address - Street 1:1801 MANHATTAN BLVD STE 172
Mailing Address - Street 2:
Mailing Address - City:HARVEY
Mailing Address - State:LA
Mailing Address - Zip Code:70058-7300
Mailing Address - Country:US
Mailing Address - Phone:504-281-3597
Mailing Address - Fax:
Practice Address - Street 1:6744 CARVER DR
Practice Address - Street 2:
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-4516
Practice Address - Country:US
Practice Address - Phone:504-281-3597
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-18
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)