Provider Demographics
NPI:1053051193
Name:RIDE-IN-OUR TRANSPORTATION SERVICE
Entity Type:Organization
Organization Name:RIDE-IN-OUR TRANSPORTATION SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RUDOLPH
Authorized Official - Middle Name:ALPHONSO
Authorized Official - Last Name:LITCHMORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-505-7462
Mailing Address - Street 1:9296 N 70TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53223-1108
Mailing Address - Country:US
Mailing Address - Phone:262-505-7462
Mailing Address - Fax:
Practice Address - Street 1:9296 N 70TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53223-1108
Practice Address - Country:US
Practice Address - Phone:262-505-7462
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-29
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100195090Medicaid