Provider Demographics
NPI:1780225573
Name:THE BLAKE EXPRESS TRANSPORTATION SERVICE
Entity Type:Organization
Organization Name:THE BLAKE EXPRESS TRANSPORTATION SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NOVELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-662-4749
Mailing Address - Street 1:1996 CAROLINA AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29115-4361
Mailing Address - Country:US
Mailing Address - Phone:803-662-4749
Mailing Address - Fax:833-836-5557
Practice Address - Street 1:1996 CAROLINA AVE
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29115-4361
Practice Address - Country:US
Practice Address - Phone:803-662-4749
Practice Address - Fax:833-836-5557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-02
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)