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Organization

EXTRAORDINARY LUXURY RIDES

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. ADDIE LEE HENTION (CO-CEO/DIRECTOR)
(470) 618-2890
Entity
Organization

Contact information

Practice address
5744 SOUTHLAND WALK, STONE MOUNTAIN, GA 30087-5291
(470) 618-2890
Mailing address
5744 SOUTHLAND WALK, STONE MOUNTAIN, GA 30087-5291
(470) 618-2890

Taxonomy

Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
347E00000X
Transportation Broker

Other

Enumeration date
02/21/2023
Last updated
02/21/2023
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