MEDICARE: HALORIDE, 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	:	1972201259
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HALORIDE, LLC

Provider Business Mailing Address
First Line	:	8658 FOUNTAIN VALLEY DR
Second Line	:
City	:	MONTGOMERY VILLAGE
State	:	MD
Zip	:	20886-5644
Country	:	US
Telephone Number	:	301-276-5452
Fax Number	:

Provider Business Practice Location Address
First Line	:	8658 FOUNTAIN VALLEY DR
Second Line	:
City	:	MONTGOMERY VILLAGE
State	:	MD
Zip	:	20886-5644
Country	:	US
Telephone Number	:	301-276-5452
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. TONNY A AKOI
Credential	:
Telephone Number	:	301-978-6226

Provider Enumeration Date	:	02/16/2023
Last Update Date	:	02/16/2023

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Directions to “HALORIDE, LLC ” Practice Location

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