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General NPI Number Information
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NPI Number | 1154638146
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Entity Type | Organization
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Legal Business Name | SURE RIDE TRANSPORT INC.
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Dates
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Enumeration Date | 09/11/2010
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Last Update Date | 09/11/2010
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Provider Practice Location Address
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Address Line | 17900 DIXIE HWY SUITE 3A
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City | HOMEWOOD
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State | IL
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Zip | 60430-1754
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Country | US
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Telephone | 708-279-9421
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Fax |
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Provider Business Mailing Address
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Address Line | 17900 DIXIE HWY SUITE 3A
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City | HOMEWOOD
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State | IL
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Zip | 60430-1754
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Country | US
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Telephone | 708-279-9421
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MS. RUNISIA D TETTER
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Credential |
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Telephone | 708-279-9421
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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 | 11662
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License Number State | IL
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