Provider Demographics
NPI:1366715385
Name:GRACEFUL CARRIERS, LLC.
Entity type:Organization
Organization Name:GRACEFUL CARRIERS, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-845-7794
Mailing Address - Street 1:440 ARNETT SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:GA
Mailing Address - Zip Code:30467-7863
Mailing Address - Country:US
Mailing Address - Phone:770-845-7794
Mailing Address - Fax:912-863-5178
Practice Address - Street 1:440 ARNETT SCHOOL RD
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:GA
Practice Address - Zip Code:30467-7863
Practice Address - Country:US
Practice Address - Phone:770-845-7794
Practice Address - Fax:912-863-5178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-22
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1353343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)