MEDICARE: BLACK EAGLE LIMOUSINE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251J00000X	Nursing Care Agency
2	344600000X	Taxi

General Provider Information

NPI Number	:	1356238265
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLACK EAGLE LIMOUSINE LLC

Provider Business Mailing Address
First Line	:	145 SHORT BRANCH RD
Second Line	:
City	:	STAFFORD
State	:	VA
Zip	:	22556-4642
Country	:	US
Telephone Number	:	202-834-9259
Fax Number	:

Provider Business Practice Location Address
First Line	:	145 SHORT BRANCH RD
Second Line	:
City	:	STAFFORD
State	:	VA
Zip	:	22556-4642
Country	:	US
Telephone Number	:	202-834-9259
Fax Number	:

Authorized Official
Title or Position	:	MANAGING PARTNER
Name	:	KHALID ZARIF
Credential	:
Telephone Number	:	202-834-9259

Provider Enumeration Date	:	06/23/2025
Last Update Date	:	06/23/2025

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Directions to “BLACK EAGLE LIMOUSINE LLC ” Practice Location

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