Healthcare Provider Details

I. General information

NPI: 1851990568
Provider Name (Legal Business Name): BLACK ENTERPRIZE CONSULTING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2020
Last Update Date: 10/22/2020
Certification Date: 10/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16701 MELFORD BLVD STE 400
BOWIE MD
20715-4411
US

IV. Provider business mailing address

12302 RONALD BEALL RD
UPPER MARLBORO MD
20774-5682
US

V. Phone/Fax

Practice location:
  • Phone: 301-388-8775
  • Fax:
Mailing address:
  • Phone: 301-388-8775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State

VIII. Authorized Official

Name: MR. JATWAN BLACK
Title or Position: CEO
Credential:
Phone: 301-388-8775