Provider Demographics
NPI:1023897667
Name:GRACEFUL RIDE LLC
Entity type:Organization
Organization Name:GRACEFUL RIDE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EDEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MEASHO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-560-3940
Mailing Address - Street 1:14362 E ARIZONA AVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-4608
Mailing Address - Country:US
Mailing Address - Phone:720-560-3940
Mailing Address - Fax:
Practice Address - Street 1:14362 E ARIZONA AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-4608
Practice Address - Country:US
Practice Address - Phone:720-560-3940
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle
No332U00000XSuppliersHome Delivered Meals
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347E00000XTransportation ServicesTransportation Broker