Provider Demographics
NPI:1508194432
Name:AZ EZ RIDE LLC
Entity Type:Organization
Organization Name:AZ EZ RIDE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NAHID
Authorized Official - Middle Name:YAGOUB
Authorized Official - Last Name:IBRAHIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-579-7652
Mailing Address - Street 1:7450 N THORNWOOD RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85741-5401
Mailing Address - Country:US
Mailing Address - Phone:520-579-7652
Mailing Address - Fax:520-572-6483
Practice Address - Street 1:7450 N THORNWOOD RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-5401
Practice Address - Country:US
Practice Address - Phone:520-579-7652
Practice Address - Fax:520-572-6483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-04
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ448591343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)