Provider Demographics
NPI:1912655309
Name:ARIDI MANOR LLC
Entity Type:Organization
Organization Name:ARIDI MANOR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADE
Authorized Official - Middle Name:
Authorized Official - Last Name:ARIDI-RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-283-8288
Mailing Address - Street 1:56 STERLING RD
Mailing Address - Street 2:
Mailing Address - City:MOOSUP
Mailing Address - State:CT
Mailing Address - Zip Code:06354-2039
Mailing Address - Country:US
Mailing Address - Phone:917-283-8288
Mailing Address - Fax:
Practice Address - Street 1:56 STERLING RD
Practice Address - Street 2:
Practice Address - City:MOOSUP
Practice Address - State:CT
Practice Address - Zip Code:06354-2039
Practice Address - Country:US
Practice Address - Phone:917-283-8288
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-14
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)