Provider Demographics
NPI:1457892390
Name:MYRIDE LLC
Entity Type:Organization
Organization Name:MYRIDE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:
Authorized Official - First Name:NORA
Authorized Official - Middle Name:
Authorized Official - Last Name:LANCASTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-649-8485
Mailing Address - Street 1:3761 PIEDRAS NEGRAS DR
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88012-7664
Mailing Address - Country:US
Mailing Address - Phone:575-382-7433
Mailing Address - Fax:575-523-8544
Practice Address - Street 1:3761 PIEDRAS NEGRAS DR
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88012-7664
Practice Address - Country:US
Practice Address - Phone:575-382-7433
Practice Address - Fax:575-523-8544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-11
Last Update Date:2017-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)