1093264418 NPI number — BLAQUE MOON ENTERPRISES LLC

Table of content: DAWN TURITTO (NPI 1720554975)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093264418 NPI number — BLAQUE MOON ENTERPRISES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BLAQUE MOON ENTERPRISES LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SANKOFA TRANSPORTATION SOLUTIONS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093264418
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/27/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 91079
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77291-1079
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
832-623-1637
Provider Business Mailing Address Fax Number:
832-487-8070

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2025 DOLLY WRIGHT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77088-7720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
832-623-1637
Provider Business Practice Location Address Fax Number:
832-487-8070
Provider Enumeration Date:
09/27/2016

Additional Information

Authorized Official

Authorized Official Last Name:
DAVIS
Authorized Official First Name:
NATALIE
Authorized Official Middle Name:
SHELENE
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
832-623-1637

Provider Taxonomy Codes

  • Taxonomy code: 343900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 347C00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 347E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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