Provider Demographics
NPI:1659601326
Name:DAUGHTERS OF THUNDER LLC
Entity Type:Organization
Organization Name:DAUGHTERS OF THUNDER LLC
Other - Org Name:DAUGHTERS OF THUNDER LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:BLANTON-PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-486-7521
Mailing Address - Street 1:PO BOX 23714
Mailing Address - Street 2:4609 S MILL
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85285-3714
Mailing Address - Country:US
Mailing Address - Phone:602-486-7521
Mailing Address - Fax:
Practice Address - Street 1:4609 S MILL AVE
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-6720
Practice Address - Country:US
Practice Address - Phone:602-486-7521
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-02
Last Update Date:2010-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ527632908251B00000X, 251S00000X, 305S00000X, 343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No305S00000XManaged Care OrganizationsPoint of Service