Provider Demographics
NPI:1912667932
Name:SMART RIDE ENTERPRISE LLC
Entity Type:Organization
Organization Name:SMART RIDE ENTERPRISE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO/OWNER/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:BUTOYI
Authorized Official - Middle Name:
Authorized Official - Last Name:PERES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:857-654-3979
Mailing Address - Street 1:3804 10TH ST
Mailing Address - Street 2:
Mailing Address - City:EAST MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61244-4519
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3804 10TH ST
Practice Address - Street 2:
Practice Address - City:EAST MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61244-4519
Practice Address - Country:US
Practice Address - Phone:857-654-3979
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-20
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)