Provider Demographics
NPI:1235160987
Name:HIS GRACE ENTERPRISE,INC
Entity Type:Organization
Organization Name:HIS GRACE ENTERPRISE,INC
Other - Org Name:HIS GRACE HOME HEALTHCARE,INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:OGUNWALE
Authorized Official - Middle Name:TOLULOPE
Authorized Official - Last Name:FOLAJU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-283-0743
Mailing Address - Street 1:318 FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:PARK FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60466-2005
Mailing Address - Country:US
Mailing Address - Phone:708-283-0743
Mailing Address - Fax:708-283-0744
Practice Address - Street 1:318 FOREST BLVD
Practice Address - Street 2:
Practice Address - City:PARK FOREST
Practice Address - State:IL
Practice Address - Zip Code:60466-2005
Practice Address - Country:US
Practice Address - Phone:708-283-0743
Practice Address - Fax:708-283-0744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL147932Medicare Oscar/Certification