Provider Demographics
NPI:1457771248
Name:GRACE MEDTRANS, LLC
Entity Type:Organization
Organization Name:GRACE MEDTRANS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:YETUNDE
Authorized Official - Middle Name:OYINLOLA
Authorized Official - Last Name:ADELEKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-908-9458
Mailing Address - Street 1:12304 JUSTICE PL
Mailing Address - Street 2:
Mailing Address - City:GLENN DALE
Mailing Address - State:MD
Mailing Address - Zip Code:20769-9176
Mailing Address - Country:US
Mailing Address - Phone:301-908-9458
Mailing Address - Fax:301-908-9458
Practice Address - Street 1:12304 JUSTICE PL
Practice Address - Street 2:
Practice Address - City:GLENN DALE
Practice Address - State:MD
Practice Address - Zip Code:20769-9176
Practice Address - Country:US
Practice Address - Phone:301-908-9458
Practice Address - Fax:301-908-9458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-21
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)