Provider Demographics
NPI:1356823611
Name:GRACE SOLUTIONS LLC
Entity Type:Organization
Organization Name:GRACE SOLUTIONS LLC
Other - Org Name:BEAUTIFUL LIFE CARE & SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDREWS
Authorized Official - Suffix:
Authorized Official - Credentials:BSN
Authorized Official - Phone:386-846-3551
Mailing Address - Street 1:12927 HIGHLAND GATE DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-1663
Mailing Address - Country:US
Mailing Address - Phone:386-846-3551
Mailing Address - Fax:
Practice Address - Street 1:12927 HIGHLAND GATE DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32224-1663
Practice Address - Country:US
Practice Address - Phone:386-846-3551
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-04
Last Update Date:2019-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL100595900Medicaid