Provider Demographics
NPI:1407392707
Name:HANDS OF GRACE NON-EMERGENCY MEDICAL TRANSPORTATION
Entity Type:Organization
Organization Name:HANDS OF GRACE NON-EMERGENCY MEDICAL TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:A
Authorized Official - Last Name:DANIEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-370-7186
Mailing Address - Street 1:4247 HACKBERRY LN
Mailing Address - Street 2:82
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-1334
Mailing Address - Country:US
Mailing Address - Phone:916-370-7186
Mailing Address - Fax:
Practice Address - Street 1:4247 HACKBERRY LN
Practice Address - Street 2:82
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-1334
Practice Address - Country:US
Practice Address - Phone:916-370-7186
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-10
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA4769597343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)