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General NPI Number Information
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NPI Number | 1689132953
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Entity Type | Organization
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Legal Business Name | GRACE AMBULANCE SERVICES LLC
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Dates
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Enumeration Date | 03/06/2019
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Last Update Date | 03/06/2019
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Provider Practice Location Address
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Address Line | 1335 LINDEN AVE
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City | HALETHORPE
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State | MD
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Zip | 21227-2407
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Country | US
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Telephone | 443-919-7778
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Fax | 443-919-7779
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Provider Business Mailing Address
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Address Line | 1335 LINDEN AVE
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City | HALETHORPE
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State | MD
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Zip | 21227-2407
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Country | US
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Telephone | 443-919-7778
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Fax | 443-919-7779
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MIRABELLE TAMBE
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Credential |
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Telephone | 443-919-7778
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number |
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License Number State |
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