Provider Demographics
NPI:1063039071
Name:SENIOR CARE RIDE, LLC
Entity Type:Organization
Organization Name:SENIOR CARE RIDE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEONILA
Authorized Official - Middle Name:V
Authorized Official - Last Name:TABAQUIN-JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-786-4539
Mailing Address - Street 1:4910 CARMELYNN ST
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-2035
Mailing Address - Country:US
Mailing Address - Phone:714-486-4539
Mailing Address - Fax:844-876-7778
Practice Address - Street 1:4910 CARMELYNN ST
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-2035
Practice Address - Country:US
Practice Address - Phone:714-486-4539
Practice Address - Fax:844-876-7778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-25
Last Update Date:2020-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)