Provider Demographics
NPI:1457718603
Name:EAGLE RIDE INC
Entity Type:Organization
Organization Name:EAGLE RIDE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ALI
Authorized Official - Middle Name:MOHAMED
Authorized Official - Last Name:IBRAHIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-636-9129
Mailing Address - Street 1:6725 ASHWOOD RD APT 310
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-2279
Mailing Address - Country:US
Mailing Address - Phone:161-263-6912
Mailing Address - Fax:
Practice Address - Street 1:6725 ASHWOOD RD APT 310
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-2279
Practice Address - Country:US
Practice Address - Phone:161-263-6912
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-19
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN209 LCB343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)