Provider Demographics
NPI:1598463309
Name:BLACK STAFFING AGENCY, LLC.
Entity Type:Organization
Organization Name:BLACK STAFFING AGENCY, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:HARDY
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-312-5013
Mailing Address - Street 1:9412 COLLETON WAY
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-8434
Mailing Address - Country:US
Mailing Address - Phone:334-312-5013
Mailing Address - Fax:
Practice Address - Street 1:9412 COLLETON WAY
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-8434
Practice Address - Country:US
Practice Address - Phone:334-312-5013
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-21
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health