Provider Demographics
NPI:1790523835
Name:AZ BLESSED TRASNPORTATION LLC
Entity type:Organization
Organization Name:AZ BLESSED TRASNPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WILLY
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUTCHOKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-699-6397
Mailing Address - Street 1:1843 N SCOTTSDALE RD
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85288-1563
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1843 N SCOTTSDALE RD
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85288-1563
Practice Address - Country:US
Practice Address - Phone:512-699-6397
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-15
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)