Provider Demographics
NPI:1508562828
Name:PRIDE RIDGE HOME CARE LLC
Entity Type:Organization
Organization Name:PRIDE RIDGE HOME CARE LLC
Other - Org Name:PRIDE RIDGE MEDICAL TRANSPORT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:WANGAI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-915-0499
Mailing Address - Street 1:2710 MORRIE DR
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68123-4091
Mailing Address - Country:US
Mailing Address - Phone:402-990-4718
Mailing Address - Fax:
Practice Address - Street 1:2710 MORRIE DR
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68123-4091
Practice Address - Country:US
Practice Address - Phone:402-990-4718
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-07
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)