Provider Demographics
NPI:1164137360
Name:EXTENDING GRACE HOME CARE LLC
Entity Type:Organization
Organization Name:EXTENDING GRACE HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANTWANIQUE
Authorized Official - Middle Name:SHAWHAN
Authorized Official - Last Name:CREWS
Authorized Official - Suffix:
Authorized Official - Credentials:BSN RN
Authorized Official - Phone:434-549-2024
Mailing Address - Street 1:139 OLD GREENSBORO ROAD DANVILLE VA 24541
Mailing Address - Street 2:SUITE A
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24541
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:139 OLD GREENSBORO ROAD DANVILLE VA 24541
Practice Address - Street 2:SUITE A
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541
Practice Address - Country:US
Practice Address - Phone:434-549-2024
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health