Provider Demographics
NPI:1124882535
Name:GECKO GRENADE LLC
Entity type:Organization
Organization Name:GECKO GRENADE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NASH
Authorized Official - Middle Name:
Authorized Official - Last Name:KINSELLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-469-6725
Mailing Address - Street 1:12519 WOODLAKE ST
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:TX
Mailing Address - Zip Code:77362-3948
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12519 WOODLAKE ST
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:TX
Practice Address - Zip Code:77362-3948
Practice Address - Country:US
Practice Address - Phone:832-469-6725
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-07
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker
No342000000XTransportation ServicesTransportation Network Company
No343800000XTransportation ServicesSecured Medical Transport (VAN)
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)