Provider Demographics
NPI:1346692803
Name:EAGLE RIDE INC
Entity Type:Organization
Organization Name:EAGLE RIDE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:GRANT
Authorized Official - Middle Name:A
Authorized Official - Last Name:AKIDI
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:914-356-7004
Mailing Address - Street 1:368 E SHEDAKER ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19144-1857
Mailing Address - Country:US
Mailing Address - Phone:484-751-7848
Mailing Address - Fax:
Practice Address - Street 1:368 E SHEDAKER ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19144-1857
Practice Address - Country:US
Practice Address - Phone:484-751-7848
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-08
Last Update Date:2016-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No344600000XTransportation ServicesTaxi