Provider Demographics
NPI:1376787051
Name:GRACE IN-HOME CARE LLC
Entity Type:Organization
Organization Name:GRACE IN-HOME CARE LLC
Other - Org Name:GIHC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANNY
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:MONTGOMERY
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:423-956-5206
Mailing Address - Street 1:22 LEE ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BRISTOL
Mailing Address - State:VA
Mailing Address - Zip Code:24201-4306
Mailing Address - Country:US
Mailing Address - Phone:276-644-9699
Mailing Address - Fax:276-644-1487
Practice Address - Street 1:22 LEE ST
Practice Address - Street 2:SUITE 100
Practice Address - City:BRISTOL
Practice Address - State:VA
Practice Address - Zip Code:24201-4306
Practice Address - Country:US
Practice Address - Phone:276-644-9699
Practice Address - Fax:276-644-1487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-27
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO-09555253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care