Provider Demographics
NPI:1285804534
Name:RIFT VALLEY TRANSPORTATION INC
Entity type:Organization
Organization Name:RIFT VALLEY TRANSPORTATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EBISSO
Authorized Official - Middle Name:K
Authorized Official - Last Name:UKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-644-5494
Mailing Address - Street 1:1821 UNIVERSITY AVE W STE S290
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-2898
Mailing Address - Country:US
Mailing Address - Phone:651-644-5494
Mailing Address - Fax:651-644-4079
Practice Address - Street 1:1821 UNIVERSITY AVE W STE S290
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-2898
Practice Address - Country:US
Practice Address - Phone:651-644-5494
Practice Address - Fax:651-644-4079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-03
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN371861343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN784485900Medicaid