Provider Demographics
NPI:1679184170
Name:BLACKLION PROTECTIVE & RISK MANAGEMENT SERVICES INC.
Entity type:Organization
Organization Name:BLACKLION PROTECTIVE & RISK MANAGEMENT SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:DOVE
Authorized Official - Middle Name:E
Authorized Official - Last Name:MOMODU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-770-2126
Mailing Address - Street 1:9730 57TH AVE APT 6E
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-3689
Mailing Address - Country:US
Mailing Address - Phone:914-770-2126
Mailing Address - Fax:
Practice Address - Street 1:9730 57TH AVE APT 6E
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-3689
Practice Address - Country:US
Practice Address - Phone:914-770-2126
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-10
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)