Provider Demographics
NPI:1144557000
Name:AZ EXPRESS RIDE LLC
Entity type:Organization
Organization Name:AZ EXPRESS RIDE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SCRUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-636-1715
Mailing Address - Street 1:429 HAYES CT
Mailing Address - Street 2:
Mailing Address - City:CHINO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86323-5703
Mailing Address - Country:US
Mailing Address - Phone:928-636-1715
Mailing Address - Fax:928-544-6982
Practice Address - Street 1:429 HAYES CT
Practice Address - Street 2:
Practice Address - City:CHINO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86323-5703
Practice Address - Country:US
Practice Address - Phone:928-636-1715
Practice Address - Fax:928-544-6982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-12
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ102587344600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi