Provider Demographics
NPI:1306208301
Name:SHEPHERD RIDE, INC.
Entity Type:Organization
Organization Name:SHEPHERD RIDE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:OKORIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-438-1822
Mailing Address - Street 1:553 SPARKLEBERRY TER NE
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-4050
Mailing Address - Country:US
Mailing Address - Phone:703-438-1822
Mailing Address - Fax:703-771-1007
Practice Address - Street 1:553 SPARKLEBERRY TER NE
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-4050
Practice Address - Country:US
Practice Address - Phone:703-438-1822
Practice Address - Fax:703-771-1007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-28
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA8364343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)