Provider Demographics
NPI:1437754520
Name:GRACE MEDICAL SUPPLY CORP
Entity Type:Organization
Organization Name:GRACE MEDICAL SUPPLY CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:AGAVNIK
Authorized Official - Middle Name:
Authorized Official - Last Name:APELYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-535-4301
Mailing Address - Street 1:8753 YATES DR STE 101
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80031-3679
Mailing Address - Country:US
Mailing Address - Phone:720-535-4301
Mailing Address - Fax:
Practice Address - Street 1:8753 YATES DR STE 101
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80031-3679
Practice Address - Country:US
Practice Address - Phone:720-535-4301
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-04
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment