MEDICARE: EA SAFE RIDE LLC

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	:	1710751300
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EA SAFE RIDE LLC

Provider Business Mailing Address
First Line	:	4155 OLD SIBLEY MEMORIAL HWY STE 101
Second Line	:
City	:	EAGAN
State	:	MN
Zip	:	55122-1948
Country	:	US
Telephone Number	:	651-367-4770
Fax Number	:

Provider Business Practice Location Address
First Line	:	2426 LEXINGTON AVE S
Second Line	:
City	:	MENDOTA HEIGHTS
State	:	MN
Zip	:	55120-1216
Country	:	US
Telephone Number	:	651-367-4770
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	HENOK ASEFA
Credential	:
Telephone Number	:	651-367-4770

Provider Enumeration Date	:	11/14/2023
Last Update Date	:	11/14/2023

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