Provider Demographics
NPI:1750058525
Name:WALLA INVESTMENT LLC
Entity Type:Organization
Organization Name:WALLA INVESTMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KHAMIS
Authorized Official - Middle Name:T
Authorized Official - Last Name:ABUZERIQ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-206-4824
Mailing Address - Street 1:PO BOX 25070
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80936-5070
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3634 CITADEL DR N UNIT A
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-5312
Practice Address - Country:US
Practice Address - Phone:720-206-4824
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-27
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)