Provider Demographics
NPI:1326746124
Name:EXTRAORDINARY LUXURY RIDES
Entity Type:Organization
Organization Name:EXTRAORDINARY LUXURY RIDES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-CEO/DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ADDIE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:HENTION
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:470-618-2890
Mailing Address - Street 1:5744 SOUTHLAND WALK
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-5291
Mailing Address - Country:US
Mailing Address - Phone:470-618-2890
Mailing Address - Fax:
Practice Address - Street 1:5744 SOUTHLAND WALK
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30087-5291
Practice Address - Country:US
Practice Address - Phone:470-618-2890
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-21
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347E00000XTransportation ServicesTransportation Broker