Provider Demographics
NPI:1134610918
Name:BENNETT LOGISTICS, LLC
Entity type:Organization
Organization Name:BENNETT LOGISTICS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:C.O.O./ LOGISTICS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-709-6059
Mailing Address - Street 1:212 GRAVATT AVE
Mailing Address - Street 2:
Mailing Address - City:BLACKSTONE
Mailing Address - State:VA
Mailing Address - Zip Code:23824-1210
Mailing Address - Country:US
Mailing Address - Phone:804-709-6059
Mailing Address - Fax:434-264-6921
Practice Address - Street 1:212 GRAVATT AVE
Practice Address - Street 2:
Practice Address - City:BLACKSTONE
Practice Address - State:VA
Practice Address - Zip Code:23824-1210
Practice Address - Country:US
Practice Address - Phone:804-709-6059
Practice Address - Fax:434-264-6921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-28
Last Update Date:2018-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA=========Medicaid