Provider Demographics
NPI:1043774284
Name:GODS GRACE HOME CARE SERVICES INC
Entity Type:Organization
Organization Name:GODS GRACE HOME CARE SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CARLY
Authorized Official - Middle Name:EMMANUEL
Authorized Official - Last Name:JEAN-LYS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:718-785-6115
Mailing Address - Street 1:22 JULIE CRES
Mailing Address - Street 2:
Mailing Address - City:CENTRAL ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11722-4908
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:22 JULIE CRES
Practice Address - Street 2:
Practice Address - City:CENTRAL ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11722-4908
Practice Address - Country:US
Practice Address - Phone:631-332-4567
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-22
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty