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General NPI Number Information
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NPI Number | 1043909385
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Entity Type | Organization
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Legal Business Name | BLACK DIAMOND TRANSPORTATION LLC
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Dates
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Enumeration Date | 05/03/2023
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Last Update Date | 05/04/2023
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Provider Practice Location Address
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Address Line | 226 ROCKBRIDGE AVE
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City | RICHLANDS
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State | VA
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Zip | 24641-2247
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Country | US
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Telephone | 276-210-3320
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Fax |
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Provider Business Mailing Address
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Address Line | 226 ROCKBRIDGE AVE
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City | RICHLANDS
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State | VA
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Zip | 24641-2247
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Country | US
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Telephone | 276-210-3320
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TARA R PRATER
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Credential | LCSW
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Telephone | 276-210-3320
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 344600000X
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Taxonomy Name | Taxi
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License Number |
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License Number State |
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