Provider Demographics
NPI:1174372882
Name:GRACE 24 RIDE LLC
Entity type:Organization
Organization Name:GRACE 24 RIDE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:REDIAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-677-8217
Mailing Address - Street 1:66 ROCKY CREEK DR APT 66
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43230-2621
Mailing Address - Country:US
Mailing Address - Phone:619-677-8217
Mailing Address - Fax:
Practice Address - Street 1:66 ROCKY CREEK DR APT 66
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43230-2621
Practice Address - Country:US
Practice Address - Phone:619-677-8217
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-15
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle
No347E00000XTransportation ServicesTransportation Broker
No342000000XTransportation ServicesTransportation Network Company
No343800000XTransportation ServicesSecured Medical Transport (VAN)