Healthcare Provider Details

I. General information

NPI: 1952797375
Provider Name (Legal Business Name): RIVERSIDE TRANSPORTATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2015
Last Update Date: 04/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 ODENTON RD
ODENTON MD
21113-1503
US

IV. Provider business mailing address

1380 ODENTON RD
ODENTON MD
21113-1503
US

V. Phone/Fax

Practice location:
  • Phone: 410-845-8687
  • Fax: 410-874-3108
Mailing address:
  • Phone: 410-845-8687
  • Fax: 410-874-3108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number4720
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code344600000X
TaxonomyTaxi
License Number
License Number State

VIII. Authorized Official

Name: MR. JONATHAN LEE GERITY SR.
Title or Position: CEO/ PRESIDENT
Credential:
Phone: 410-845-8687