MEDICARE: CRYSTAL RIDES TRANSPORTATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1235087255
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CRYSTAL RIDES TRANSPORTATION

Provider Business Mailing Address
First Line	:	2701 SUNSET LN
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92407-0234
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5709 LYONS VIEW PIKE
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37919-6462
Country	:	US
Telephone Number	:	909-717-2622
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	VONDRAI SKILLERN
Credential	:
Telephone Number	:	909-717-2622

Provider Enumeration Date	:	03/17/2026
Last Update Date	:	03/17/2026

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Directions to “CRYSTAL RIDES TRANSPORTATION ” Practice Location

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