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General NPI Number Information
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NPI Number | 1114458783
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Entity Type | Organization
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Legal Business Name | DESTINEE RIDES INC.
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Dates
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Enumeration Date | 03/24/2017
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Last Update Date | 03/24/2017
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Provider Practice Location Address
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Address Line | 11 COMMONS LN UNIT 12
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City | POUGHKEEPSIE
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State | NY
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Zip | 12601-7615
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Country | US
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Telephone | 845-464-4477
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Fax | 845-454-0736
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Provider Business Mailing Address
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Address Line | PO BOX 4995
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City | POUGHKEEPSIE
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State | NY
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Zip | 12602-4995
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Country | US
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Telephone | 845-464-4477
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Fax | 845-454-0736
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Authorized Official
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Title or Position | CEO
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Name | MRS. ROCHELLE A IRVING
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Credential | LPN
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Telephone | 845-453-5113
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number | 38934
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License Number State | NY
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