Provider Demographics
NPI:1841011285
Name:MY RIDE LCC
Entity type:Organization
Organization Name:MY RIDE LCC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:ABES
Authorized Official - Last Name:VAN SANDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-727-4111
Mailing Address - Street 1:PO BOX 670417
Mailing Address - Street 2:
Mailing Address - City:CHUGIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99567-0417
Mailing Address - Country:US
Mailing Address - Phone:907-727-4111
Mailing Address - Fax:
Practice Address - Street 1:19651 SCENIC DR.
Practice Address - Street 2:
Practice Address - City:CHUGIAK
Practice Address - State:AK
Practice Address - Zip Code:99567
Practice Address - Country:US
Practice Address - Phone:907-947-2398
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-18
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)