Provider Demographics
NPI:1558805218
Name:AMBER GRACE LLC
Entity Type:Organization
Organization Name:AMBER GRACE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:LAMONT
Authorized Official - Last Name:HARDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-839-6607
Mailing Address - Street 1:3301 CREEK MEADOW CIR
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23234-6717
Mailing Address - Country:US
Mailing Address - Phone:804-839-6607
Mailing Address - Fax:804-271-6440
Practice Address - Street 1:3301 CREEK MEADOW CIR
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23234-6717
Practice Address - Country:US
Practice Address - Phone:804-839-6607
Practice Address - Fax:804-271-6440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-14
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA513343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)