Provider Demographics
NPI:1114458783
Name:DESTINEE RIDES INC.
Entity Type:Organization
Organization Name:DESTINEE RIDES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROCHELLE
Authorized Official - Middle Name:A
Authorized Official - Last Name:IRVING
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:845-453-5113
Mailing Address - Street 1:PO BOX 4995
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12602-4995
Mailing Address - Country:US
Mailing Address - Phone:845-464-4477
Mailing Address - Fax:845-454-0736
Practice Address - Street 1:11 COMMONS LN
Practice Address - Street 2:UNIT 12
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-7615
Practice Address - Country:US
Practice Address - Phone:845-464-4477
Practice Address - Fax:845-454-0736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-24
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY38934343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03765079Medicaid