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General NPI Number Information
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NPI Number | 1518933217
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Entity Type | Organization
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Legal Business Name | EZ RYDER KREATIVE MOBILE LIFESTYLES INC
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Dates
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Enumeration Date | 02/23/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 10302 FAYETTEVILLE RD
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City | FAYETTEVILLE
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State | NC
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Zip | 28304-9133
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Country | US
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Telephone | 910-904-1700
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Fax | 910-904-6800
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Provider Business Mailing Address
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Address Line | 10302 FAYETTEVILLE RD
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City | FAYETTEVILLE
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State | NC
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Zip | 28304-9133
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Country | US
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Telephone | 910-904-1700
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Fax | 910-904-6800
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. JUANITA W BAREFOOT
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Credential |
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Telephone | 910-904-1700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 00349
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number | 00349
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License Number State | NC
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