Provider Demographics
NPI:1225682453
Name:BLACK CORAL TRANSPORT SERVICES LLC
Entity Type:Organization
Organization Name:BLACK CORAL TRANSPORT SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:U
Authorized Official - Last Name:KAAIALII
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-861-7108
Mailing Address - Street 1:89-782 ILIMAPAPA PL
Mailing Address - Street 2:
Mailing Address - City:WAIANAE
Mailing Address - State:HI
Mailing Address - Zip Code:96792-3901
Mailing Address - Country:US
Mailing Address - Phone:808-861-7108
Mailing Address - Fax:808-888-8442
Practice Address - Street 1:89-782 ILIMAPAPA PL
Practice Address - Street 2:
Practice Address - City:WAIANAE
Practice Address - State:HI
Practice Address - Zip Code:96792-3901
Practice Address - Country:US
Practice Address - Phone:808-861-7108
Practice Address - Fax:808-888-8442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-25
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)