Provider Demographics
NPI:1578122537
Name:GRACE AND MERCY TRANSPORTATION INC
Entity Type:Organization
Organization Name:GRACE AND MERCY TRANSPORTATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMEL
Authorized Official - Middle Name:LAMONT
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-410-1323
Mailing Address - Street 1:14 TANNENBAUM CIR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-9686
Mailing Address - Country:US
Mailing Address - Phone:336-410-1323
Mailing Address - Fax:336-285-5341
Practice Address - Street 1:704 MARTIN ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27406-1739
Practice Address - Country:US
Practice Address - Phone:336-410-1323
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-12
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3295679OtherDOT