Provider Demographics
NPI:1003395500
Name:GRANT YOUR WISH MEDICAL TRANSPORT
Entity Type:Organization
Organization Name:GRANT YOUR WISH MEDICAL TRANSPORT
Other - Org Name:GRANT YOUR WISH SENIOR TRANSPORTATION SERVICES, LLC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:VICTORIA
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-916-5502
Mailing Address - Street 1:1140 KILDAIRE FARM RD
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-4562
Mailing Address - Country:US
Mailing Address - Phone:919-916-5502
Mailing Address - Fax:919-916-5502
Practice Address - Street 1:1140 KILDAIRE FARM RD STE 308-2
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-4562
Practice Address - Country:US
Practice Address - Phone:919-916-5502
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-07
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)