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General NPI Number Information
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NPI Number | 1235087255
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Entity Type | Organization
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Legal Business Name | CRYSTAL RIDES TRANSPORTATION
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Dates
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Enumeration Date | 03/17/2026
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Last Update Date | 03/17/2026
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Provider Practice Location Address
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Address Line | 5709 LYONS VIEW PIKE
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City | KNOXVILLE
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State | TN
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Zip | 37919-6462
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Country | US
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Telephone | 909-717-2622
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Fax |
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Provider Business Mailing Address
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Address Line | 2701 SUNSET LN
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City | SAN BERNARDINO
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State | CA
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Zip | 92407-0234
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | VONDRAI SKILLERN
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Credential |
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Telephone | 909-717-2622
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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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