Provider Demographics
NPI:1750167516
Name:GLORYRIDE
Entity type:Organization
Organization Name:GLORYRIDE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SELENA
Authorized Official - Middle Name:LETITIA
Authorized Official - Last Name:HALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-231-4247
Mailing Address - Street 1:5363 S ZENO WAY
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80015-4601
Mailing Address - Country:US
Mailing Address - Phone:720-231-4247
Mailing Address - Fax:
Practice Address - Street 1:3000 S JAMAICA CT STE 100
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-4601
Practice Address - Country:US
Practice Address - Phone:720-231-4247
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)