Provider Demographics
NPI:1518674803
Name:BASSA 365 ENTERPRISES
Entity Type:Organization
Organization Name:BASSA 365 ENTERPRISES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASST MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEFLORIMONTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-491-4478
Mailing Address - Street 1:4208 IDLEWILD DR
Mailing Address - Street 2:
Mailing Address - City:FRUITLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:34731-5638
Mailing Address - Country:US
Mailing Address - Phone:321-239-7936
Mailing Address - Fax:
Practice Address - Street 1:4208 IDLEWILD DR
Practice Address - Street 2:
Practice Address - City:FRUITLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:34731-5638
Practice Address - Country:US
Practice Address - Phone:321-239-7936
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-04
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLL22000138068OtherARTICLES OF ORGANIZATION