Provider Demographics
NPI:1689132953
Name:GRACE AMBULANCE SERVICES LLC
Entity Type:Organization
Organization Name:GRACE AMBULANCE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MIRABELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:TAMBE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-919-7778
Mailing Address - Street 1:1335 LINDEN AVE
Mailing Address - Street 2:
Mailing Address - City:HALETHORPE
Mailing Address - State:MD
Mailing Address - Zip Code:21227-2407
Mailing Address - Country:US
Mailing Address - Phone:443-919-7778
Mailing Address - Fax:443-919-7779
Practice Address - Street 1:1335 LINDEN AVE
Practice Address - Street 2:
Practice Address - City:HALETHORPE
Practice Address - State:MD
Practice Address - Zip Code:21227-2407
Practice Address - Country:US
Practice Address - Phone:443-919-7778
Practice Address - Fax:443-919-7779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-06
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport