Provider Demographics
NPI:1679111538
Name:BLUE LIFE TRANSPORTATION MANAGEMENT LLC
Entity Type:Organization
Organization Name:BLUE LIFE TRANSPORTATION MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:VASQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PRESIDENT
Authorized Official - Phone:786-439-5798
Mailing Address - Street 1:7400 STIRLING RD APT 1013
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-1539
Mailing Address - Country:US
Mailing Address - Phone:786-439-5798
Mailing Address - Fax:
Practice Address - Street 1:7400 STIRLING RD APT 1013
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-1539
Practice Address - Country:US
Practice Address - Phone:786-439-5798
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-11
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL104272300Medicaid