Healthcare Provider Details

I. General information

NPI: 1912833773
Provider Name (Legal Business Name): GRACE MOBILITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 CHERRY ST APT B
EVANSVILLE IN
47713-1019
US

IV. Provider business mailing address

115 CHERRY ST APT B
EVANSVILLE IN
47713-1019
US

V. Phone/Fax

Practice location:
  • Phone: 812-568-0548
  • Fax:
Mailing address:
  • Phone: 812-568-0548
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: BRIAN MATTINGLY
Title or Position: CEO
Credential:
Phone: 812-568-0548