Organization
ICCABI LLC
Active
Other names
PRIVATE RIDES
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TYRE GRINAGE (CEO)
(812) 647-7960
Entity
Organization
Contact information
Practice address
1458 RIDGEWAY DRIVE, JEFFERSONVILLE, IN 47130
(812) 647-7960
Mailing address
1458 RIDGEWAY DR, JEFFERSONVILLE, IN 47130-6174
(812) 647-7960
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
—
—
Other
Enumeration date
11/16/2023
Last updated
11/16/2023
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