Provider Demographics
NPI:1922829258
Name:GREAT RIDE TRANSPORT
Entity type:Organization
Organization Name:GREAT RIDE TRANSPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WOODSON
Authorized Official - Middle Name:
Authorized Official - Last Name:PIERRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:857-236-8252
Mailing Address - Street 1:28 CHURCH ST STE 14
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01890-2538
Mailing Address - Country:US
Mailing Address - Phone:857-395-8999
Mailing Address - Fax:
Practice Address - Street 1:28 CHURCH ST STE 14
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:MA
Practice Address - Zip Code:01890-2538
Practice Address - Country:US
Practice Address - Phone:857-395-8999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-19
Last Update Date:2024-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)