MEDICARE: GRACE TRANSPORTATION LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1063936490
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRACE TRANSPORTATION LLC

Provider Business Mailing Address
First Line	:	PO BOX 342762
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53234-2762
Country	:	US
Telephone Number	:	414-937-0256
Fax Number	:	414-800-7776

Provider Business Practice Location Address
First Line	:	2002 W ROOSEVELT DR
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53209-6322
Country	:	US
Telephone Number	:	414-937-0256
Fax Number	:	414-800-7776

Authorized Official
Title or Position	:	CEO
Name	:	MS. SONYA CHEREAS BLAND
Credential	:
Telephone Number	:	414-937-0256

Provider Enumeration Date	:	07/27/2017
Last Update Date	:	07/21/2022

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Directions to “GRACE TRANSPORTATION LLC ” Practice Location

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