Provider Demographics
NPI:1114464849
Name:GRACE HOME HEALTH CARE AGENCY, LLC
Entity Type:Organization
Organization Name:GRACE HOME HEALTH CARE AGENCY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BERTRAM
Authorized Official - Middle Name:OTUODICHINMA
Authorized Official - Last Name:OPARAJI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-393-4345
Mailing Address - Street 1:2127 E 26TH ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66046-5624
Mailing Address - Country:US
Mailing Address - Phone:785-393-4345
Mailing Address - Fax:785-865-3927
Practice Address - Street 1:2127 E 26TH ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66046-5624
Practice Address - Country:US
Practice Address - Phone:785-393-4345
Practice Address - Fax:785-865-3927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-19
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health