Provider Demographics
NPI:1639714827
Name:LIVING GOLDEN ELDER RIDE VIRGINIA TRANSPORT LLC
Entity Type:Organization
Organization Name:LIVING GOLDEN ELDER RIDE VIRGINIA TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON-FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-833-4477
Mailing Address - Street 1:4352 MYLAN RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23223-2274
Mailing Address - Country:US
Mailing Address - Phone:804-833-4477
Mailing Address - Fax:804-833-4477
Practice Address - Street 1:4352 MYLAN RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23223-2274
Practice Address - Country:US
Practice Address - Phone:804-833-4477
Practice Address - Fax:804-918-9007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-12
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)