Provider Demographics
NPI:1770956500
Name:LIBERTY RIDES INC.
Entity type:Organization
Organization Name:LIBERTY RIDES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:CRETTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-507-4332
Mailing Address - Street 1:PO BOX 95
Mailing Address - Street 2:
Mailing Address - City:BENNETT
Mailing Address - State:CO
Mailing Address - Zip Code:80102-0095
Mailing Address - Country:US
Mailing Address - Phone:720-507-4332
Mailing Address - Fax:
Practice Address - Street 1:155 N COUNTY ROAD 133
Practice Address - Street 2:
Practice Address - City:BENNETT
Practice Address - State:CO
Practice Address - Zip Code:80102-8607
Practice Address - Country:US
Practice Address - Phone:720-507-4332
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-02
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)