Healthcare Provider Details

I. General information

NPI: 1538048087
Provider Name (Legal Business Name): AMAZING GRACE TRANSPORTATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2025
Last Update Date: 08/28/2025
Certification Date: 08/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

639 E SAN MARNAN DR
WATERLOO IA
50702-5605
US

IV. Provider business mailing address

639 E SAN MARNAN DR
WATERLOO IA
50702-5605
US

V. Phone/Fax

Practice location:
  • Phone: 508-982-7707
  • Fax:
Mailing address:
  • Phone: 508-982-7707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code342000000X
TaxonomyTransportation Network Company
License Number
License Number StateNULL

VIII. Authorized Official

Name: ESTHER NYAMBURA KIMANI
Title or Position: CEO
Credential:
Phone: 508-982-7707