Provider Demographics
NPI:1194382465
Name:STARIDE INC
Entity Type:Organization
Organization Name:STARIDE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ABDISAMIA
Authorized Official - Middle Name:
Authorized Official - Last Name:JEILANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-306-5030
Mailing Address - Street 1:6189 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-5720
Mailing Address - Country:US
Mailing Address - Phone:619-306-5030
Mailing Address - Fax:619-488-1386
Practice Address - Street 1:6189 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92115-5720
Practice Address - Country:US
Practice Address - Phone:619-306-5030
Practice Address - Fax:619-488-1386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-22
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)