Provider Demographics
NPI:1124651724
Name:GRACE EMS, LLC
Entity type:Organization
Organization Name:GRACE EMS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:ERWIN
Authorized Official - Last Name:BURNETTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-472-2311
Mailing Address - Street 1:PO BOX 2331
Mailing Address - Street 2:
Mailing Address - City:BLAIRSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30514-2331
Mailing Address - Country:US
Mailing Address - Phone:877-472-2311
Mailing Address - Fax:877-472-2339
Practice Address - Street 1:91 DAVID BURNETTE DR
Practice Address - Street 2:
Practice Address - City:BLAIRSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30512-5102
Practice Address - Country:US
Practice Address - Phone:877-472-2311
Practice Address - Fax:877-472-2339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-21
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport