Provider Demographics
NPI:1528897030
Name:BLAKK DIAMOND LLC
Entity type:Organization
Organization Name:BLAKK DIAMOND LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:G
Authorized Official - Last Name:BUGGAGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-957-2072
Mailing Address - Street 1:501 LOGAN ISLAND CT
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-5825
Mailing Address - Country:US
Mailing Address - Phone:504-957-2072
Mailing Address - Fax:985-288-0646
Practice Address - Street 1:501 LOGAN ISLAND CT
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-5825
Practice Address - Country:US
Practice Address - Phone:504-957-2072
Practice Address - Fax:985-288-0646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-01
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)