Provider Demographics
NPI:1962983676
Name:GRACE TRANSPORTATION LLC
Entity type:Organization
Organization Name:GRACE TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORIO
Authorized Official - Middle Name:
Authorized Official - Last Name:PACHECO
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:585-285-1026
Mailing Address - Street 1:970 MONROE AVE # S16
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620-1728
Mailing Address - Country:US
Mailing Address - Phone:585-285-1026
Mailing Address - Fax:
Practice Address - Street 1:970 MONROE AVE # S16
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-1728
Practice Address - Country:US
Practice Address - Phone:585-285-1026
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-22
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04619169Medicaid