Provider Demographics
NPI:1437918489
Name:GRANDE TRANSPORTATION, LLC
Entity Type:Organization
Organization Name:GRANDE TRANSPORTATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:MONTIEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:971-336-4392
Mailing Address - Street 1:11103 SANTIAGO RIVER LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77406-3206
Mailing Address - Country:US
Mailing Address - Phone:971-336-4392
Mailing Address - Fax:
Practice Address - Street 1:11103 SANTIAGO RIVER LN
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77406-3206
Practice Address - Country:US
Practice Address - Phone:971-336-4392
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-13
Last Update Date:2024-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)