Provider Demographics
NPI:1467724278
Name:GRACE HOME HEALTH CARE, INC,
Entity Type:Organization
Organization Name:GRACE HOME HEALTH CARE, INC,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/DIRECTOR OF NURSING
Authorized Official - Prefix:MS
Authorized Official - First Name:LAVETA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:WOODSON-JARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:620-899-9883
Mailing Address - Street 1:206 KISIWA PARKWAY
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:KS
Mailing Address - Zip Code:67502-4436
Mailing Address - Country:US
Mailing Address - Phone:620-899-9883
Mailing Address - Fax:
Practice Address - Street 1:206 KISIWA PARKWAY
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67502-4436
Practice Address - Country:US
Practice Address - Phone:620-899-9883
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-09
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health