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General NPI Number Information
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NPI Number | 1124874862
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Entity Type | Organization
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Legal Business Name | ADAPTIVERIDE LLC
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Dates
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Enumeration Date | 04/24/2024
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Last Update Date | 06/06/2024
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Provider Practice Location Address
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Address Line | 4664 CAYMAN CT
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City | STOCKTON
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State | CA
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Zip | 95210-5690
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Country | US
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Telephone | 209-489-6779
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Fax |
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Provider Business Mailing Address
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Address Line | 4664 CAYMAN CT
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City | STOCKTON
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State | CA
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Zip | 95210-5690
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Country | US
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Telephone | 209-489-6779
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JOHN MOHAMED TARAWALI
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Credential | ADMINISTRATOR
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Telephone | 209-489-6779
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 347E00000X
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Taxonomy Name | Transportation Broker
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License Number |
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License Number State |
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