Provider Demographics
NPI:1225403090
Name:SHEPHERD'S GRACE HOME HEALTH
Entity Type:Organization
Organization Name:SHEPHERD'S GRACE HOME HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NIKARLO
Authorized Official - Middle Name:
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-213-0437
Mailing Address - Street 1:5005 NATALIE DR
Mailing Address - Street 2:
Mailing Address - City:BRYANT
Mailing Address - State:AR
Mailing Address - Zip Code:72022-9231
Mailing Address - Country:US
Mailing Address - Phone:501-213-0437
Mailing Address - Fax:501-943-7254
Practice Address - Street 1:5005 NATALIE DR
Practice Address - Street 2:
Practice Address - City:BRYANT
Practice Address - State:AR
Practice Address - Zip Code:72022-9231
Practice Address - Country:US
Practice Address - Phone:501-213-0437
Practice Address - Fax:501-943-7254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-04
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR0859580251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health