Provider Demographics
NPI:1760046346
Name:GRACE MEDICAL LLC
Entity Type:Organization
Organization Name:GRACE MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMANUEL
Authorized Official - Middle Name:B
Authorized Official - Last Name:MANNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-548-7664
Mailing Address - Street 1:24687 E ALAMO PL
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80016-4473
Mailing Address - Country:US
Mailing Address - Phone:720-548-7664
Mailing Address - Fax:
Practice Address - Street 1:24687 E ALAMO PL
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80016-4473
Practice Address - Country:US
Practice Address - Phone:720-548-7664
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-29
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)