Provider Demographics
NPI:1760920292
Name:BLANK-PAGES LLC
Entity type:Organization
Organization Name:BLANK-PAGES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LASHAY
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-567-9199
Mailing Address - Street 1:4019 NIGHT HERON CT
Mailing Address - Street 2:B
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603-4673
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3200 CRAIN HWY
Practice Address - Street 2:203
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20603-4841
Practice Address - Country:US
Practice Address - Phone:202-567-9199
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-03
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC6054251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD251042100Medicaid
MD879798OtherBEACON