Provider Demographics
NPI:1063644540
Name:HEALTH RIDE TRANSPORTATION LLC
Entity Type:Organization
Organization Name:HEALTH RIDE TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:XAITSAV
Authorized Official - Middle Name:
Authorized Official - Last Name:PHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-772-8140
Mailing Address - Street 1:1008 ARCADE ST
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55106-3246
Mailing Address - Country:US
Mailing Address - Phone:763-772-8140
Mailing Address - Fax:
Practice Address - Street 1:1008 ARCADE ST
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55106-3246
Practice Address - Country:US
Practice Address - Phone:763-772-8140
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-17
Last Update Date:2009-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)