Provider Demographics
NPI:1326652231
Name:EMMA GRACE HOMES LLC
Entity Type:Organization
Organization Name:EMMA GRACE HOMES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MENOCCA
Authorized Official - Middle Name:
Authorized Official - Last Name:ABRAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-803-1102
Mailing Address - Street 1:600 JEFFERIS CT
Mailing Address - Street 2:
Mailing Address - City:EUSTIS
Mailing Address - State:FL
Mailing Address - Zip Code:32726-5114
Mailing Address - Country:US
Mailing Address - Phone:407-803-1102
Mailing Address - Fax:
Practice Address - Street 1:600 JEFFERIS CT
Practice Address - Street 2:
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32726-5114
Practice Address - Country:US
Practice Address - Phone:352-308-8794
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-08
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376G00000XNursing Service Related ProvidersNursing Home AdministratorGroup - Single Specialty