Provider Demographics
NPI:1437877537
Name:GRACE HOME HEALTHCARE SERVICES
Entity Type:Organization
Organization Name:GRACE HOME HEALTHCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KOLLEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-629-7620
Mailing Address - Street 1:11059 E BETHANY DR STE 104
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-2617
Mailing Address - Country:US
Mailing Address - Phone:317-629-7620
Mailing Address - Fax:
Practice Address - Street 1:11059 E BETHANY DR STE 104
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-2617
Practice Address - Country:US
Practice Address - Phone:317-629-7620
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-16
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251E00000XAgenciesHome Health