Provider Demographics
NPI:1679990329
Name:LIBERTY RIDE LLC
Entity Type:Organization
Organization Name:LIBERTY RIDE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MARLO
Authorized Official - Middle Name:RITA
Authorized Official - Last Name:TERSIGNI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-514-3930
Mailing Address - Street 1:529 MAIN ST # 1M5
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-1125
Mailing Address - Country:US
Mailing Address - Phone:978-514-3930
Mailing Address - Fax:
Practice Address - Street 1:65 LAKE AVE
Practice Address - Street 2:APT. 831
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01604-1199
Practice Address - Country:US
Practice Address - Phone:978-514-3930
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-19
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAS86649214343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)