Healthcare Provider Details

I. General information

NPI: 1770956500
Provider Name (Legal Business Name): LIBERTY RIDES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2015
Last Update Date: 11/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 N COUNTY ROAD 133
BENNETT CO
80102-8607
US

IV. Provider business mailing address

PO BOX 95
BENNETT CO
80102-0095
US

V. Phone/Fax

Practice location:
  • Phone: 720-507-4332
  • Fax:
Mailing address:
  • Phone: 720-507-4332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JONATHAN DAVID CRETTI
Title or Position: PRESIDENT
Credential:
Phone: 720-507-4332