Provider Demographics
NPI:1770951154
Name:SMOOTH RIDE SERVICES, LLC
Entity type:Organization
Organization Name:SMOOTH RIDE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FILIMON
Authorized Official - Middle Name:MOGOS
Authorized Official - Last Name:GEBRHIWET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-422-8380
Mailing Address - Street 1:3854 SOUTH EVANSTON ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014
Mailing Address - Country:US
Mailing Address - Phone:720-422-8380
Mailing Address - Fax:
Practice Address - Street 1:16492 E WYOMING DR
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80017
Practice Address - Country:US
Practice Address - Phone:720-422-8380
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-02
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COB-10050343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)