Healthcare Provider Details

I. General information

NPI: 1124482286
Provider Name (Legal Business Name): PRIDE TRANSPORTATION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2016
Last Update Date: 04/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 PENDLETON RD
FREDERICKSBURG VA
22405-3040
US

IV. Provider business mailing address

27 PENDLETON RD
FREDERICKSBURG VA
22405-3040
US

V. Phone/Fax

Practice location:
  • Phone: 540-419-7766
  • Fax: 540-373-7766
Mailing address:
  • Phone: 540-419-7766
  • Fax: 540-373-7766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License NumberT60873761
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License NumberT60873761
License Number StateVA

VIII. Authorized Official

Name: MS. LATARSHA PRIDE
Title or Position: OWNER - MEMBER
Credential:
Phone: 540-419-7766