Provider Demographics
NPI:1225804727
Name:GRACE HOME HEALTHCARE LLC
Entity Type:Organization
Organization Name:GRACE HOME HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CLIFF
Authorized Official - Middle Name:
Authorized Official - Last Name:AWEANUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-243-5253
Mailing Address - Street 1:2140 ACADEMY CIR STE 1
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-1690
Mailing Address - Country:US
Mailing Address - Phone:719-243-5253
Mailing Address - Fax:
Practice Address - Street 1:2140 ACADEMY CIR STE 1
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-1690
Practice Address - Country:US
Practice Address - Phone:719-243-5253
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care