Provider Demographics
NPI:1336505072
Name:HOMERIDE TRANSPORTATION LLC
Entity Type:Organization
Organization Name:HOMERIDE TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YASIN
Authorized Official - Middle Name:HASSAN
Authorized Official - Last Name:ALI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-992-9071
Mailing Address - Street 1:2940 PILLSBURY AVE S STE 205
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-2275
Mailing Address - Country:US
Mailing Address - Phone:952-992-9071
Mailing Address - Fax:
Practice Address - Street 1:563 38TH AVE NE
Practice Address - Street 2:
Practice Address - City:COLUMBIA HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55421-3802
Practice Address - Country:US
Practice Address - Phone:612-703-6589
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-11
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN381626343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)