Provider Demographics
NPI:1871885723
Name:GRACE AMBULANCE TRANSPORT LLC
Entity type:Organization
Organization Name:GRACE AMBULANCE TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAKEISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-838-0800
Mailing Address - Street 1:6800 WEST LOOP S
Mailing Address - Street 2:STE 300
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-4528
Mailing Address - Country:US
Mailing Address - Phone:713-838-0800
Mailing Address - Fax:713-838-0887
Practice Address - Street 1:6800 WEST LOOP S
Practice Address - Street 2:STE 300
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-4528
Practice Address - Country:US
Practice Address - Phone:713-838-0800
Practice Address - Fax:713-838-0887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-11
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========OtherEIN