Provider Demographics
NPI:1306739107
Name:SNAKE RIVER RIDES, LLC.
Entity type:Organization
Organization Name:SNAKE RIVER RIDES, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ISAAC
Authorized Official - Middle Name:B
Authorized Official - Last Name:MOFFETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-608-3998
Mailing Address - Street 1:PO BOX 384
Mailing Address - Street 2:
Mailing Address - City:BUHL
Mailing Address - State:ID
Mailing Address - Zip Code:83316-0384
Mailing Address - Country:US
Mailing Address - Phone:208-608-3998
Mailing Address - Fax:
Practice Address - Street 1:1160 E 3600 N
Practice Address - Street 2:
Practice Address - City:BUHL
Practice Address - State:ID
Practice Address - Zip Code:83316-6202
Practice Address - Country:US
Practice Address - Phone:208-608-3998
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-30
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)