Provider Demographics
NPI:1912609462
Name:YOUR RIDE TRANSPORT, LLC
Entity Type:Organization
Organization Name:YOUR RIDE TRANSPORT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:DONALD
Authorized Official - Last Name:NICKLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-375-1221
Mailing Address - Street 1:PO BOX 1125
Mailing Address - Street 2:
Mailing Address - City:ENNIS
Mailing Address - State:TX
Mailing Address - Zip Code:75120-1125
Mailing Address - Country:US
Mailing Address - Phone:785-375-1221
Mailing Address - Fax:972-875-6276
Practice Address - Street 1:107 S GAINES ST STE 104
Practice Address - Street 2:
Practice Address - City:ENNIS
Practice Address - State:TX
Practice Address - Zip Code:75119-4612
Practice Address - Country:US
Practice Address - Phone:785-375-1221
Practice Address - Fax:972-875-6276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-20
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343800000XTransportation ServicesSecured Medical Transport (VAN)