Provider Demographics
NPI:1437898525
Name:GRACE HOMECARE SERVICES LLC
Entity Type:Organization
Organization Name:GRACE HOMECARE SERVICES LLC
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 1:4238 VIVA LN
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46239-1911
Mailing Address - Country:US
Mailing Address - Phone:317-629-7620
Mailing Address - Fax:
Practice Address - Street 1:4238 VIVA LN
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46239-1911
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:2022-05-27
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282J00000XHospitalsReligious Nonmedical Health Care Institution