Provider Demographics
NPI:1760080477
Name:PALMS PRIDE INC
Entity Type:Organization
Organization Name:PALMS PRIDE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:KISEKKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-373-3460
Mailing Address - Street 1:38 PEQUOT STREET
Mailing Address - Street 2:
Mailing Address - City:N. BILLERICA
Mailing Address - State:MA
Mailing Address - Zip Code:01862
Mailing Address - Country:US
Mailing Address - Phone:781-373-3460
Mailing Address - Fax:
Practice Address - Street 1:38 PEQUOT STREET
Practice Address - Street 2:
Practice Address - City:N. BILLERICA
Practice Address - State:MA
Practice Address - Zip Code:01862
Practice Address - Country:US
Practice Address - Phone:781-373-3460
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-14
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)