Provider Demographics
NPI:1073223764
Name:TOUCH OF GRACE LIVING ASSISTANCE SERVICES LLC
Entity Type:Organization
Organization Name:TOUCH OF GRACE LIVING ASSISTANCE SERVICES LLC
Other - Org Name:TOUCH OF GRACE LIVING ASSISTANCE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:DEVON
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-849-3945
Mailing Address - Street 1:13817 VILLAGE MILL DR STE H&I
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23114-4378
Mailing Address - Country:US
Mailing Address - Phone:757-849-3945
Mailing Address - Fax:
Practice Address - Street 1:13817 VILLAGE MILL DR STE H&I
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23114-4378
Practice Address - Country:US
Practice Address - Phone:804-464-2881
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-02
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA30017510640001Medicaid
VAHC0-233081OtherCOMMONWEALTH OF VIRGINIA DEPARTMENT OF HEALTH