Provider Demographics
NPI:1114700572
Name:LOVE AND GRACE HOME CARE
Entity Type:Organization
Organization Name:LOVE AND GRACE HOME CARE
Other - Org Name:LOVE AND GRACE HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KAYLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:COOKE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:463-249-7130
Mailing Address - Street 1:8342 QUETICO DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-1986
Mailing Address - Country:US
Mailing Address - Phone:463-249-7130
Mailing Address - Fax:
Practice Address - Street 1:8342 QUETICO DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-1986
Practice Address - Country:US
Practice Address - Phone:463-249-7130
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-17
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty