Provider Demographics
NPI:1801387485
Name:GOOD RIDE TRANSPORT LLC
Entity Type:Organization
Organization Name:GOOD RIDE TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:PRUST
Authorized Official - Middle Name:
Authorized Official - Last Name:CENATUS
Authorized Official - Suffix:
Authorized Official - Credentials:GM
Authorized Official - Phone:321-318-9967
Mailing Address - Street 1:308 MAYBECK CT
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-9527
Mailing Address - Country:US
Mailing Address - Phone:321-318-9967
Mailing Address - Fax:
Practice Address - Street 1:308 MAYBECK CT
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-9527
Practice Address - Country:US
Practice Address - Phone:321-318-9967
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-20
Last Update Date:2018-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
343900000X
FL199550343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)