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General NPI Number Information
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NPI Number | 1063936490
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Entity Type | Organization
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Legal Business Name | GRACE TRANSPORTATION LLC
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Dates
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Enumeration Date | 07/27/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 2002 W ROOSEVELT DR
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City | MILWAUKEE
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State | WI
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Zip | 53209-6322
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Country | US
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Telephone | 414-937-0256
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Fax | 414-800-7776
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Provider Business Mailing Address
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Address Line | PO BOX 342762
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City | MILWAUKEE
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State | WI
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Zip | 53234-2762
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Country | US
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Telephone | 414-937-0256
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Fax | 414-800-7776
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Authorized Official
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Title or Position | CEO
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Name | MS. SONYA CHEREAS BLAND
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Credential |
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Telephone | 414-937-0256
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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