Provider Demographics
NPI:1679216709
Name:AMAZINGRIDE
Entity Type:Organization
Organization Name:AMAZINGRIDE
Other - Org Name:AMAZINGRIDE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SALEBAN
Authorized Official - Middle Name:YUSUF
Authorized Official - Last Name:WARSAME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-644-5505
Mailing Address - Street 1:27 14TH AVE N APT 313
Mailing Address - Street 2:
Mailing Address - City:HOPKINS
Mailing Address - State:MN
Mailing Address - Zip Code:55343-7472
Mailing Address - Country:US
Mailing Address - Phone:612-644-5505
Mailing Address - Fax:
Practice Address - Street 1:27 14TH AVE N APT 313
Practice Address - Street 2:
Practice Address - City:HOPKINS
Practice Address - State:MN
Practice Address - Zip Code:55343-7472
Practice Address - Country:US
Practice Address - Phone:612-644-5505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-17
Last Update Date:2022-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)