Provider Demographics
NPI:1346870201
Name:THE GRACE HOME HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:THE GRACE HOME HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROSELYN
Authorized Official - Middle Name:CHINYERE
Authorized Official - Last Name:NKWOCHA
Authorized Official - Suffix:
Authorized Official - Credentials:RN,BSN
Authorized Official - Phone:763-300-1902
Mailing Address - Street 1:7710 BROOKLYN BLVD STE 206A
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55443-2938
Mailing Address - Country:US
Mailing Address - Phone:763-300-1902
Mailing Address - Fax:
Practice Address - Street 1:9707 PENN AVE N
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55444-1031
Practice Address - Country:US
Practice Address - Phone:763-300-1902
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-20
Last Update Date:2020-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
No3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances