Provider Demographics
NPI:1285005272
Name:GRACE HS LLC
Entity Type:Organization
Organization Name:GRACE HS LLC
Other - Org Name:GRACE HEALTHCARE SERVICES, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:STERN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-567-0400
Mailing Address - Street 1:14C 53RD ST
Mailing Address - Street 2:SUITE 220
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11232-2644
Mailing Address - Country:US
Mailing Address - Phone:718-567-0400
Mailing Address - Fax:718-567-0600
Practice Address - Street 1:105 FIELDCREST AVE
Practice Address - Street 2:SUITE 402
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08837-3628
Practice Address - Country:US
Practice Address - Phone:866-447-0246
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-15
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ24015251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0108707Medicaid
NJ0108707Medicaid