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General NPI Number Information
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NPI Number | 1740974013
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Entity Type | Organization
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Legal Business Name | BON VOYAGE TRANSPORT
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Dates
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Enumeration Date | 06/08/2023
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Last Update Date | 06/08/2023
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Provider Practice Location Address
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Address Line | 2251 WEBB ST APT 201
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City | DETROIT
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State | MI
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Zip | 48206-3337
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Country | US
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Telephone | 248-993-6482
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Fax |
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Provider Business Mailing Address
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Address Line | 2251 WEBB ST APT 201
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City | DETROIT
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State | MI
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Zip | 48206-3337
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Country | US
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Telephone | 248-993-6482
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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 | JERMAINE NEWSOME
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Credential |
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Telephone | 248-993-1905
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number |
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License Number State |
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