Provider Demographics
NPI:1508605833
Name:JEDA RIDE TRANSPORTATION LLC
Entity type:Organization
Organization Name:JEDA RIDE TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JERUSALEM
Authorized Official - Middle Name:DESALEGN
Authorized Official - Last Name:DERBEW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-791-0536
Mailing Address - Street 1:8250 MEADOW RD # 6314
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-3745
Mailing Address - Country:US
Mailing Address - Phone:214-791-0536
Mailing Address - Fax:
Practice Address - Street 1:12225 GREENVILLE AVE STE 703
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-9362
Practice Address - Country:US
Practice Address - Phone:214-791-0536
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-24
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343800000XTransportation ServicesSecured Medical Transport (VAN)