The Mahogany Berry LLC

Primary specialty

Non-emergency Medical Transport (VAN)Taxonomy code 343900000X

Legal business name

THE MAHOGANY BERRY LLC

Practice address

1425 Schoenherr Ave
Bolingbrook, IL 60490-3216

Phone

(619) 204-7688

NPI assigned

Dec 2, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Damien Jamar Woodbury

Title

Owner

Phone

(619) 204-7688

Specialties & licenses 2

Addresses

Other names 1

• TMB Transport Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1733097600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733097600000",
    "number": "1669298121",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1425 SCHOENHERR AVE",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604903216",
            "telephone_number": "619-204-7688"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1425 SCHOENHERR AVE",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604903216",
            "telephone_number": "619-204-7688"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE MAHOGANY BERRY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-12-02",
        "last_updated": "2024-12-02",
        "certification_date": "2024-12-01",
        "status": "A",
        "authorized_official_last_name": "WOODBURY",
        "authorized_official_first_name": "DAMIEN",
        "authorized_official_middle_name": "JAMAR",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "619-204-7688",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "342000000X",
            "taxonomy_group": "",
            "desc": "Transportation Network Company",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "343900000X",
            "taxonomy_group": "",
            "desc": "Non-emergency Medical Transport (VAN)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "TMB Transport",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Non-emergency Medical Transport (VAN) in Bolingbrook, IL
• Providers in Bolingbrook, IL by specialty
• Non-emergency Medical Transport (VAN) in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.