Provider Demographics
NPI:1790316339
Name:GRATEFUL MEDICAL TRANSPORTATION
Entity Type:Organization
Organization Name:GRATEFUL MEDICAL TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:BROADNAX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-728-3793
Mailing Address - Street 1:361 BARRETT ST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24541-5123
Mailing Address - Country:US
Mailing Address - Phone:434-728-3793
Mailing Address - Fax:
Practice Address - Street 1:2276 FRANKLIN TPKE STE 121
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24540-5284
Practice Address - Country:US
Practice Address - Phone:434-728-3793
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-02
Last Update Date:2020-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)