Provider Demographics
NPI:1275121451
Name:BLADEE ENTERPRISE INTERNATIONAL COMPANY LLC
Entity Type:Organization
Organization Name:BLADEE ENTERPRISE INTERNATIONAL COMPANY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WELLINGTON
Authorized Official - Middle Name:
Authorized Official - Last Name:CARNGBE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-632-7758
Mailing Address - Street 1:4006 ESPADA LEDGE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78222-3476
Mailing Address - Country:US
Mailing Address - Phone:210-632-7758
Mailing Address - Fax:
Practice Address - Street 1:4006 ESPADA LEDGE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78222-3476
Practice Address - Country:US
Practice Address - Phone:210-632-7758
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-04
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No251E00000XAgenciesHome Health