Provider Demographics
NPI:1740870948
Name:BELLA BLAKES NEMT SERVES
Entity type:Organization
Organization Name:BELLA BLAKES NEMT SERVES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ROCHERICA
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAKES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-210-6472
Mailing Address - Street 1:8946 KINGSTON RD
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71118-2730
Mailing Address - Country:US
Mailing Address - Phone:318-828-2488
Mailing Address - Fax:
Practice Address - Street 1:8946 KINGSTON RD
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71118-2730
Practice Address - Country:US
Practice Address - Phone:318-828-2488
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-21
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)