Provider Demographics
NPI:1922831197
Name:PEACEANDGRACETRANSPORTATION
Entity type:Organization
Organization Name:PEACEANDGRACETRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WALLACE
Authorized Official - Middle Name:W
Authorized Official - Last Name:FENNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-284-5128
Mailing Address - Street 1:813 POND VIEW HTS
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14612-1350
Mailing Address - Country:US
Mailing Address - Phone:585-284-5128
Mailing Address - Fax:
Practice Address - Street 1:813 POND VIEW HTS
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14612-1350
Practice Address - Country:US
Practice Address - Phone:585-284-5128
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-23
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No261QM1103XAmbulatory Health Care FacilitiesClinic/CenterMilitary Ambulatory Procedure Visits Operational (Transportable)
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No292200000XLaboratoriesDental Laboratory
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child