Provider Demographics
NPI:1962978338
Name:BOLOMS TRANSPORT SERVICES, LLC
Entity type:Organization
Organization Name:BOLOMS TRANSPORT SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BOLO
Authorized Official - Middle Name:
Authorized Official - Last Name:SOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-408-0461
Mailing Address - Street 1:6405 MAPLE HILLS DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48301-1323
Mailing Address - Country:US
Mailing Address - Phone:248-408-0461
Mailing Address - Fax:
Practice Address - Street 1:6405 MAPLE HILLS DR
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48301-1323
Practice Address - Country:US
Practice Address - Phone:248-408-0461
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-23
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)