Provider Demographics
NPI:1811459506
Name:RIDE AWAY LLC
Entity type:Organization
Organization Name:RIDE AWAY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGED MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ELFRIEDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:PEGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-972-2083
Mailing Address - Street 1:2016 GLEN ABBEY ST
Mailing Address - Street 2:
Mailing Address - City:ATWATER
Mailing Address - State:CA
Mailing Address - Zip Code:95301-4842
Mailing Address - Country:US
Mailing Address - Phone:619-972-1398
Mailing Address - Fax:
Practice Address - Street 1:2016 GLEN ABBEY ST
Practice Address - Street 2:
Practice Address - City:ATWATER
Practice Address - State:CA
Practice Address - Zip Code:95301-4842
Practice Address - Country:US
Practice Address - Phone:619-972-1398
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RIDE AWAY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-04-02
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker