Provider Demographics
NPI:1861374373
Name:BA AUGUST LLC
Entity type:Organization
Organization Name:BA AUGUST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-986-7836
Mailing Address - Street 1:PO BOX 260237
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PNES
Mailing Address - State:FL
Mailing Address - Zip Code:33026-7237
Mailing Address - Country:US
Mailing Address - Phone:305-986-7836
Mailing Address - Fax:
Practice Address - Street 1:9645 NW 1ST CT APT 1-308
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-6277
Practice Address - Country:US
Practice Address - Phone:305-986-7836
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-24
Last Update Date:2025-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies