Provider Demographics
NPI:1154055523
Name:LORDS SAVING GRACE HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:LORDS SAVING GRACE HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LASHANTA
Authorized Official - Middle Name:SHANENE
Authorized Official - Last Name:ROBERSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:912-665-0686
Mailing Address - Street 1:1108 RIDDICK LN
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31407-4060
Mailing Address - Country:US
Mailing Address - Phone:191-266-5068
Mailing Address - Fax:
Practice Address - Street 1:1108 RIDDICK LN
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31407-4060
Practice Address - Country:US
Practice Address - Phone:191-266-5068
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-12
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care