Provider Demographics
NPI:1063113280
Name:ROOTS RIDE LLC
Entity type:Organization
Organization Name:ROOTS RIDE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BINYAM
Authorized Official - Middle Name:S
Authorized Official - Last Name:AYNALEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-585-8400
Mailing Address - Street 1:261 QUARI ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80011-8339
Mailing Address - Country:US
Mailing Address - Phone:720-585-8400
Mailing Address - Fax:303-474-3957
Practice Address - Street 1:261 QUARI ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80011-8339
Practice Address - Country:US
Practice Address - Phone:720-585-8400
Practice Address - Fax:303-474-3957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-14
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)