MEDICARE: SECURE 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	:	1720935851
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SECURE RIDE LLC

Provider Business Mailing Address
First Line	:	25490 S 227TH ST
Second Line	:
City	:	QUEEN CREEK
State	:	AZ
Zip	:	85142-2124
Country	:	US
Telephone Number	:	480-208-2407
Fax Number	:

Provider Business Practice Location Address
First Line	:	25490 S 227TH ST
Second Line	:
City	:	QUEEN CREEK
State	:	AZ
Zip	:	85142-2124
Country	:	US
Telephone Number	:	480-208-2407
Fax Number	:

Authorized Official
Title or Position	:	OWNER MANAGER
Name	:	TILAHUN WAGAYE
Credential	:
Telephone Number	:	480-208-2407

Provider Enumeration Date	:	03/16/2026
Last Update Date	:	03/16/2026

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