Provider Demographics
NPI:1700018132
Name:GRACE ON WINGS, INCORPORATED
Entity Type:Organization
Organization Name:GRACE ON WINGS, INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:HAL
Authorized Official - Middle Name:H
Authorized Official - Last Name:BLANK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-248-0910
Mailing Address - Street 1:5128 E STOP 11 RD STE 37
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-6338
Mailing Address - Country:US
Mailing Address - Phone:317-248-0910
Mailing Address - Fax:317-248-0900
Practice Address - Street 1:5128 E STOP 11 RD STE 37
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-6338
Practice Address - Country:US
Practice Address - Phone:317-248-0910
Practice Address - Fax:317-248-0900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-18
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN11103416A0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416A0800XTransportation ServicesAmbulanceAir Transport