Provider Demographics
NPI:1518933217
Name:EZ RYDER KREATIVE MOBILE LIFESTYLES INC
Entity Type:Organization
Organization Name:EZ RYDER KREATIVE MOBILE LIFESTYLES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JUANITA
Authorized Official - Middle Name:W
Authorized Official - Last Name:BAREFOOT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-904-1700
Mailing Address - Street 1:10302 FAYETTEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-9133
Mailing Address - Country:US
Mailing Address - Phone:910-904-1700
Mailing Address - Fax:910-904-6800
Practice Address - Street 1:10302 FAYETTEVILLE RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-9133
Practice Address - Country:US
Practice Address - Phone:910-904-1700
Practice Address - Fax:910-904-6800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC00349332B00000X, 332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7702047Medicaid
NC7702047Medicaid