Provider Demographics
NPI:1235696485
Name:GRACE COMMUNITY HOSPICE CARE, LLC
Entity Type:Organization
Organization Name:GRACE COMMUNITY HOSPICE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IJAZ
Authorized Official - Middle Name:
Authorized Official - Last Name:YAQOOB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-598-7822
Mailing Address - Street 1:14184 22 MILE RD
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48315-4210
Mailing Address - Country:US
Mailing Address - Phone:989-598-7822
Mailing Address - Fax:
Practice Address - Street 1:14184 22 MILE RD
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48315-4210
Practice Address - Country:US
Practice Address - Phone:989-598-7822
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-25
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based