Provider Demographics
NPI:1285339374
Name:GRACE NON-EMERGENCY MEDICAL TRANSPORTATION LLC
Entity type:Organization
Organization Name:GRACE NON-EMERGENCY MEDICAL TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ESHETU
Authorized Official - Middle Name:G
Authorized Official - Last Name:DAGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-430-9144
Mailing Address - Street 1:6502 CHARLOTTE AVE SE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98092-8334
Mailing Address - Country:US
Mailing Address - Phone:206-430-9144
Mailing Address - Fax:
Practice Address - Street 1:6502 CHARLOTTE AVE SE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98092-8334
Practice Address - Country:US
Practice Address - Phone:206-430-9144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-30
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)