Provider Demographics
NPI:1154638146
Name:SURE RIDE TRANSPORT INC.
Entity Type:Organization
Organization Name:SURE RIDE TRANSPORT INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:RUNISIA
Authorized Official - Middle Name:D
Authorized Official - Last Name:TETTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-279-9421
Mailing Address - Street 1:17900 DIXIE HWY
Mailing Address - Street 2:SUITE 3A
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430-1754
Mailing Address - Country:US
Mailing Address - Phone:708-279-9421
Mailing Address - Fax:
Practice Address - Street 1:17900 DIXIE HWY
Practice Address - Street 2:SUITE 3A
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-1754
Practice Address - Country:US
Practice Address - Phone:708-279-9421
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-11
Last Update Date:2010-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL11662343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)