Provider Demographics
NPI:1124803713
Name:BLULEAF SENIOR TRANSPORTATION
Entity type:Organization
Organization Name:BLULEAF SENIOR TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAMEKA
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITTED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-717-3885
Mailing Address - Street 1:506 RAMSEUR ST
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27701-4891
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:506 RAMSEUR ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27701-4891
Practice Address - Country:US
Practice Address - Phone:919-717-3885
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-30
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)