=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821702069
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RIDING IN GRACE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/11/2023
-----------------------------------------------------
Last Update Date | 02/06/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3801 GREENBRIER DR
-----------------------------------------------------
City | MELISSA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75454-0777
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 89-084-2687
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 539 W COMMERCE ST STE 683
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75208-1953
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-945-3852
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | COO
-----------------------------------------------------
Name | MARIA COWLES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 708-601-2326
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343800000X
-----------------------------------------------------
Taxonomy Name | Secured Medical Transport (VAN)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 347C00000X
-----------------------------------------------------
Taxonomy Name | Private Vehicle
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------