Provider Demographics
NPI:1093113805
Name:GRACE HEALTHCARE SERVICES LLC
Entity Type:Organization
Organization Name:GRACE HEALTHCARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:BASSEY
Authorized Official - Middle Name:
Authorized Official - Last Name:EKANEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-447-7584
Mailing Address - Street 1:3519 PELHAM RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4181
Mailing Address - Country:US
Mailing Address - Phone:864-438-2635
Mailing Address - Fax:
Practice Address - Street 1:3519 PELHAM RD
Practice Address - Street 2:SUITE 104
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-4181
Practice Address - Country:US
Practice Address - Phone:864-438-2635
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GRACE HEALTHCARE SERVICES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-12-10
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1406110221251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health