Provider Demographics
NPI:1629750658
Name:MAYA RIDE LLC
Entity Type:Organization
Organization Name:MAYA RIDE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GESSESSE
Authorized Official - Middle Name:TEMESGEN
Authorized Official - Last Name:WORKNEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-884-5085
Mailing Address - Street 1:15586 E 12TH AVE APT 301
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80011-7363
Mailing Address - Country:US
Mailing Address - Phone:602-884-5085
Mailing Address - Fax:
Practice Address - Street 1:15586 E 12TH AVE APT 301
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80011-7363
Practice Address - Country:US
Practice Address - Phone:602-884-5085
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-01
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)