Provider Demographics
NPI:1285476556
Name:DERIDE LLC
Entity type:Organization
Organization Name:DERIDE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ADEGOKE
Authorized Official - Middle Name:
Authorized Official - Last Name:ODELABU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-545-6669
Mailing Address - Street 1:79 GENERAL ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-1611
Mailing Address - Country:US
Mailing Address - Phone:401-347-9182
Mailing Address - Fax:401-421-1401
Practice Address - Street 1:79 GENERAL ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-1611
Practice Address - Country:US
Practice Address - Phone:401-347-9182
Practice Address - Fax:401-421-1401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-08
Last Update Date:2024-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)