Provider Demographics
NPI:1760172332
Name:HABESHARIDE NEMT LLC
Entity Type:Organization
Organization Name:HABESHARIDE NEMT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ABRAHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:RETA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-415-5358
Mailing Address - Street 1:5400 MEMORIAL DR APT 5F
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30083-3217
Mailing Address - Country:US
Mailing Address - Phone:970-415-5358
Mailing Address - Fax:
Practice Address - Street 1:5400 MEMORIAL DR APT 5F
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30083-3217
Practice Address - Country:US
Practice Address - Phone:970-415-5358
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-08
Last Update Date:2023-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)