Provider Demographics
NPI:1497324198
Name:PROVIDEARIDE LLC
Entity Type:Organization
Organization Name:PROVIDEARIDE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:BREANA
Authorized Official - Middle Name:
Authorized Official - Last Name:FOXX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-952-0855
Mailing Address - Street 1:109 KINGSBURY DR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-1741
Mailing Address - Country:US
Mailing Address - Phone:216-952-0855
Mailing Address - Fax:
Practice Address - Street 1:109 KINGSBURY DR
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-1741
Practice Address - Country:US
Practice Address - Phone:216-952-0855
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-18
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)