Provider Demographics
NPI:1528681509
Name:GRACE RIDE LLC
Entity type:Organization
Organization Name:GRACE RIDE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MR.
Authorized Official - Prefix:MR
Authorized Official - First Name:BIRUK
Authorized Official - Middle Name:
Authorized Official - Last Name:HAILU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-937-0768
Mailing Address - Street 1:5201 E COLFAX AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-1303
Mailing Address - Country:US
Mailing Address - Phone:720-937-0768
Mailing Address - Fax:
Practice Address - Street 1:5201 E COLFAX AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-1303
Practice Address - Country:US
Practice Address - Phone:720-937-0768
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-25
Last Update Date:2020-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)