Provider Demographics
NPI:1306401476
Name:AMAZING GRACE TRANSPORT SERVICE
Entity Type:Organization
Organization Name:AMAZING GRACE TRANSPORT SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONNETT
Authorized Official - Middle Name:STACEY-ANN
Authorized Official - Last Name:TYNDALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-774-1759
Mailing Address - Street 1:5293 PIRATA PL
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-1980
Mailing Address - Country:US
Mailing Address - Phone:757-524-5859
Mailing Address - Fax:
Practice Address - Street 1:5293 PIRATA PL
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-1980
Practice Address - Country:US
Practice Address - Phone:757-524-5859
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-04
Last Update Date:2019-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA343900000XOtherTRANSPORTATION SERVICE NON EMERGENCY MEDICAL TRANSPORT VAN