Provider Demographics
NPI:1174351985
Name:SERENITY MEDICAL RIDES
Entity type:Organization
Organization Name:SERENITY MEDICAL RIDES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:GLEN
Authorized Official - Last Name:CHLARSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:385-231-9192
Mailing Address - Street 1:PO BOX 442
Mailing Address - Street 2:
Mailing Address - City:MORONI
Mailing Address - State:UT
Mailing Address - Zip Code:84646-0442
Mailing Address - Country:US
Mailing Address - Phone:435-314-4726
Mailing Address - Fax:
Practice Address - Street 1:382 N CENTER ST
Practice Address - Street 2:
Practice Address - City:MORONI
Practice Address - State:UT
Practice Address - Zip Code:84646-7647
Practice Address - Country:US
Practice Address - Phone:435-314-4726
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-23
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)