Healthcare Provider Details

I. General information

NPI: 1801751094
Provider Name (Legal Business Name): HOUSING SUPPORT RIDES, INCORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

917 EDMUND AVE
SAINT PAUL MN
55104-2621
US

IV. Provider business mailing address

917 EDMUND AVE
SAINT PAUL MN
55104-2621
US

V. Phone/Fax

Practice location:
  • Phone: 763-501-7764
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KONG MENG VANG
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 763-501-7764