Provider Demographics
NPI:1932759446
Name:RIVERSIDE LINE EXPRESS LLC
Entity Type:Organization
Organization Name:RIVERSIDE LINE EXPRESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MUGISHA
Authorized Official - Middle Name:F
Authorized Official - Last Name:SAHINI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-602-8497
Mailing Address - Street 1:115 30TH STREET DR SE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52403-1402
Mailing Address - Country:US
Mailing Address - Phone:716-602-8497
Mailing Address - Fax:
Practice Address - Street 1:115 30TH STREET DR SE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52403-1402
Practice Address - Country:US
Practice Address - Phone:716-602-8497
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-17
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY532730579Medicaid