Provider Demographics
NPI:1003591231
Name:SHARP RIDE LLC
Entity Type:Organization
Organization Name:SHARP RIDE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MERON
Authorized Official - Middle Name:M
Authorized Official - Last Name:RUSSOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-470-5895
Mailing Address - Street 1:1463 E 96TH LN
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80229-7814
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1463 E 96TH LN
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80229-7814
Practice Address - Country:US
Practice Address - Phone:720-470-5895
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-15
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)