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General NPI Number Information
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NPI Number | 1578409298
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Entity Type | Organization
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Legal Business Name | BLACK HOUSE REAL ESTATE LLC
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Dates
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Enumeration Date | 04/25/2026
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Last Update Date | 04/25/2026
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Provider Practice Location Address
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Address Line | 3800 CAMP CREEK PKWY BUILDING 1400 STE 116B #400
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City | ATLANTA
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State | GA
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Zip | 30331
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Country | US
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Telephone | 404-401-3616
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Fax |
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Provider Business Mailing Address
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Address Line | 3800 CAMP CREEK PKWY BUILDING 1400 STE 116B #400
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City | ATLANTA
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State | GA
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Zip | 30331
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Country | US
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Telephone | 404-401-3616
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | SKYE SMITH
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Credential |
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Telephone | 251-648-2910
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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