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General NPI Number Information
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NPI Number | 1740779123
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Entity Type | Organization
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Legal Business Name | LION OF JUDAH MASS TRANSIT LLC
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Dates
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Enumeration Date | 05/01/2018
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Last Update Date | 09/12/2018
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Provider Practice Location Address
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Address Line | 6811 KENILWORTH AVE STE 500
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City | RIVERDALE
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State | MD
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Zip | 20737-1318
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Country | US
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Telephone | 240-342-1156
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Fax |
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Provider Business Mailing Address
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Address Line | 6811 KENILWORTH AVE STE 500
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City | RIVERDALE
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State | MD
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Zip | 20737-1318
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Country | US
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Telephone | 240-342-1156
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BLAISE OGECHI OSUJI
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Credential |
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Telephone | 240-342-1156
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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 | 3145
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License Number State | MD
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