Provider Demographics
NPI:1821860719
Name:MILKY WAY RIDE LLC
Entity Type:Organization
Organization Name:MILKY WAY RIDE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAZEB
Authorized Official - Middle Name:MERSHA
Authorized Official - Last Name:BELAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-492-2816
Mailing Address - Street 1:PO BOX 370685
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-0685
Mailing Address - Country:US
Mailing Address - Phone:720-492-2816
Mailing Address - Fax:
Practice Address - Street 1:3891 IVY HILL DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80922-3082
Practice Address - Country:US
Practice Address - Phone:720-492-2816
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-24
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)