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General NPI Number Information
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NPI Number | 1548776743
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Entity Type | Organization
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Legal Business Name | SUPREME LIMOUSINE LLC
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Dates
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Enumeration Date | 12/26/2017
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Last Update Date | 12/26/2017
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Provider Practice Location Address
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Address Line | 504 MAIN ST STE 105
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City | FARMINGTON
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State | CT
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Zip | 06032-2984
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Country | US
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Telephone | 860-284-0508
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Fax | 860-284-0519
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Provider Business Mailing Address
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Address Line | 504 MAIN ST STE 105
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City | FARMINGTON
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State | CT
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Zip | 06032-2984
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Country | US
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Telephone | 860-284-0508
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Fax | 860-284-0519
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Authorized Official
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Title or Position | OWNER
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Name | MR. ABDUL MAJID
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Credential |
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Telephone | 860-682-8063
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 347E00000X
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Taxonomy Name | Transportation Broker
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License Number | P-2515
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License Number State | CT
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