Provider Demographics
NPI:1487765541
Name:HEALTH RIDE VAN, LLC
Entity type:Organization
Organization Name:HEALTH RIDE VAN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICE
Authorized Official - Prefix:
Authorized Official - First Name:NATE
Authorized Official - Middle Name:
Authorized Official - Last Name:MEYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-847-5611
Mailing Address - Street 1:PO BOX 1410
Mailing Address - Street 2:
Mailing Address - City:DETROIT LAKES
Mailing Address - State:MN
Mailing Address - Zip Code:56502-1410
Mailing Address - Country:US
Mailing Address - Phone:218-847-0817
Mailing Address - Fax:218-847-0842
Practice Address - Street 1:1240 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:DETROIT LAKES
Practice Address - State:MN
Practice Address - Zip Code:56501-3906
Practice Address - Country:US
Practice Address - Phone:218-847-0817
Practice Address - Fax:218-847-0842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN198222343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN81-20881OtherMEDICA
ND51792Medicaid
MN9G009MAOtherBCBS OF MINNESOTA