Provider Demographics
NPI:1922700913
Name:AMAZING GRACE NEMT
Entity Type:Organization
Organization Name:AMAZING GRACE NEMT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TORYAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-498-0158
Mailing Address - Street 1:212 SHORTER AVE NW STE 1088
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-4288
Mailing Address - Country:US
Mailing Address - Phone:706-622-8713
Mailing Address - Fax:
Practice Address - Street 1:122 PINE BOWER DR NW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-1024
Practice Address - Country:US
Practice Address - Phone:706-622-8713
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-21
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)