Provider Demographics
NPI:1366782724
Name:MY RIDE TRANSPORTATION, LLC
Entity type:Organization
Organization Name:MY RIDE TRANSPORTATION, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT/ EXECUTIVE SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAMILLE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROLFE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-779-4998
Mailing Address - Street 1:224 BOND DR
Mailing Address - Street 2:
Mailing Address - City:FORREST CITY
Mailing Address - State:AR
Mailing Address - Zip Code:72335-7822
Mailing Address - Country:US
Mailing Address - Phone:615-779-4998
Mailing Address - Fax:501-319-7482
Practice Address - Street 1:224 BOND DR
Practice Address - Street 2:
Practice Address - City:FORREST CITY
Practice Address - State:AR
Practice Address - Zip Code:72335-7822
Practice Address - Country:US
Practice Address - Phone:615-779-4998
Practice Address - Fax:501-319-7482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-21
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN112005089343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)