Provider Demographics
NPI:1407401441
Name:GRACE TRANSPORTATION LLC
Entity Type:Organization
Organization Name:GRACE TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SENAIT
Authorized Official - Middle Name:KIFLU
Authorized Official - Last Name:TESFAMARIAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-436-0147
Mailing Address - Street 1:1141 S BIRCH ST APT 208
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80246-3028
Mailing Address - Country:US
Mailing Address - Phone:720-436-0147
Mailing Address - Fax:
Practice Address - Street 1:1141 S BIRCH ST APT 208
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80246-3028
Practice Address - Country:US
Practice Address - Phone:720-436-0147
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-06
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)