Provider Demographics
NPI:1811487804
Name:BLUE RAY LLC
Entity type:Organization
Organization Name:BLUE RAY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER/DRIVER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:C
Authorized Official - Last Name:JAGER
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:239-244-1228
Mailing Address - Street 1:4345 STEINBECK WAY
Mailing Address - Street 2:
Mailing Address - City:AVE MARIA
Mailing Address - State:FL
Mailing Address - Zip Code:34142-5011
Mailing Address - Country:US
Mailing Address - Phone:239-244-1228
Mailing Address - Fax:
Practice Address - Street 1:4345 STEINBECK WAY
Practice Address - Street 2:
Practice Address - City:AVE MARIA
Practice Address - State:FL
Practice Address - Zip Code:34142-5011
Practice Address - Country:US
Practice Address - Phone:239-244-1228
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BLUE RAY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-05-15
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)