Healthcare Provider Details

I. General information

NPI: 1962983676
Provider Name (Legal Business Name): GRACE TRANSPORTATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2018
Last Update Date: 08/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

970 MONROE AVE # S16
ROCHESTER NY
14620-1728
US

IV. Provider business mailing address

970 MONROE AVE # S16
ROCHESTER NY
14620-1728
US

V. Phone/Fax

Practice location:
  • Phone: 585-285-1026
  • Fax:
Mailing address:
  • Phone: 585-285-1026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code344600000X
TaxonomyTaxi
License Number
License Number State

VIII. Authorized Official

Name: MR. GREGORIO PACHECO
Title or Position: OWNER CEO
Credential: OWNER
Phone: 585-285-1026