MEDICARE: BLESSED COMMUNITY TRANSPORTATION LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1336499029
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLESSED COMMUNITY TRANSPORTATION LLC

Provider Business Mailing Address
First Line	:	1345 W CHIMES ST
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70802-8538
Country	:	US
Telephone Number	:	225-650-3024
Fax Number	:	225-300-4388

Provider Business Practice Location Address
First Line	:	1249 AVENUE B
Second Line	:
City	:	PORT ALLEN
State	:	LA
Zip	:	70767-2858
Country	:	US
Telephone Number	:	225-650-3024
Fax Number	:	225-300-4388

Authorized Official
Title or Position	:	MEMBER/MANAGER
Name	:	MRS. WANDA EACKLES JACKSON
Credential	:
Telephone Number	:	225-650-3024

Provider Enumeration Date	:	09/11/2012
Last Update Date	:	09/11/2012

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