Provider Demographics
NPI:1942077656
Name:CEDAR RIDGE TRANSPORTATION LLC
Entity Type:Organization
Organization Name:CEDAR RIDGE TRANSPORTATION LLC
Other - Org Name:LIFELINE MEDICAL TRANSPORTATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:SOON
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-540-1249
Mailing Address - Street 1:115 E DAVIS ST STE B
Mailing Address - Street 2:
Mailing Address - City:DUNCANVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75116-3642
Mailing Address - Country:US
Mailing Address - Phone:469-236-1987
Mailing Address - Fax:
Practice Address - Street 1:115 E DAVIS ST STE B
Practice Address - Street 2:
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75116-3642
Practice Address - Country:US
Practice Address - Phone:469-236-1987
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)