Provider Demographics
NPI:1639862006
Name:WELLNESS RIDE
Entity Type:Organization
Organization Name:WELLNESS RIDE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALAZAR
Authorized Official - Middle Name:M
Authorized Official - Last Name:BIRHANU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-940-9324
Mailing Address - Street 1:1201 N HUDSON AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57104-1042
Mailing Address - Country:US
Mailing Address - Phone:605-940-9324
Mailing Address - Fax:
Practice Address - Street 1:1201 N HUDSON AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57104-1042
Practice Address - Country:US
Practice Address - Phone:605-940-9324
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-31
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)