Provider Demographics
NPI:1750707436
Name:IRIDE INC.
Entity type:Organization
Organization Name:IRIDE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MURAVEYNIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-220-0024
Mailing Address - Street 1:17678 72ND AVE N
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55311-2742
Mailing Address - Country:US
Mailing Address - Phone:763-220-0024
Mailing Address - Fax:813-501-1131
Practice Address - Street 1:17678 72ND AVE N
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55311-2742
Practice Address - Country:US
Practice Address - Phone:763-220-0024
Practice Address - Fax:813-501-1131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-05
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)