Provider Demographics
NPI:1336499029
Name:BLESSED COMMUNITY TRANSPORTATION LLC
Entity Type:Organization
Organization Name:BLESSED COMMUNITY TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:EACKLES
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-650-3024
Mailing Address - Street 1:1345 W CHIMES ST
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70802-8538
Mailing Address - Country:US
Mailing Address - Phone:225-650-3024
Mailing Address - Fax:225-300-4388
Practice Address - Street 1:1249 AVENUE B
Practice Address - Street 2:
Practice Address - City:PORT ALLEN
Practice Address - State:LA
Practice Address - Zip Code:70767-2858
Practice Address - Country:US
Practice Address - Phone:225-650-3024
Practice Address - Fax:225-300-4388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-11
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)