Provider Demographics
NPI:1487173670
Name:MELANCON'S RIDE THERAPY L.L.C.
Entity type:Organization
Organization Name:MELANCON'S RIDE THERAPY L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DEITRAS
Authorized Official - Middle Name:K
Authorized Official - Last Name:MELANCON
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:504-818-6015
Mailing Address - Street 1:4219 S BROAD ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70125-3659
Mailing Address - Country:US
Mailing Address - Phone:504-818-6015
Mailing Address - Fax:504-309-1930
Practice Address - Street 1:4219 S BROAD ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70125-3659
Practice Address - Country:US
Practice Address - Phone:504-818-6015
Practice Address - Fax:504-309-1930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-19
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
343900000X
LA6004233343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA6004233OtherTRANSPOTATION