BOOMER RIDE; NPI #1194121210

Contact Information

BOOMER RIDE

724 5TH ST W APT B
HASTINGS, MN 55033-1745

Phone: 651-263-0189
Fax:
Website:

	Specialty	Taxonomy Code	Specialty Code	Provider Type
	Private Vehicle	347C00000X

Indicates primary specialty

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NPI Profile & details for BOOMER RIDE

NPI Number 1194121210

LBN Legal business name BOOMER RIDE

Authorized official LESLIE HOWARD - (OWNER)

Entity Organization

Organization subpart ¹ No

Enumeration date 11/17/2014

Last updated 11/17/2014 - About 12 years ago

Identifiers

License #

C893012006120

¹ Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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BOOMER RIDE

Contact Information

Specialty

Private Vehicle

NPI Profile & details for BOOMER RIDE

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