Healthcare Provider Details

I. General information

NPI: 1588568125
Provider Name (Legal Business Name): KHNAM RIDE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10062 E WYOMING PL APT 2214
AURORA CO
80247-6372
US

IV. Provider business mailing address

10062 E WYOMING PL APT 2214
AURORA CO
80247-6372
US

V. Phone/Fax

Practice location:
  • Phone: 720-319-1728
  • Fax:
Mailing address:
  • Phone: 720-319-1728
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateNULL

VIII. Authorized Official

Name: KASAHUN AKOLOM
Title or Position: OWNER
Credential:
Phone: 720-319-1728