Provider Demographics
NPI:1497436356
Name:LA GRACE HOME CARE SERVICES LLC
Entity Type:Organization
Organization Name:LA GRACE HOME CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AMBR
Authorized Official - Prefix:
Authorized Official - First Name:MYESHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-215-5025
Mailing Address - Street 1:18960 N SAN JUAN ST
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85138-2536
Mailing Address - Country:US
Mailing Address - Phone:402-215-5025
Mailing Address - Fax:
Practice Address - Street 1:18960 N SAN JUAN ST
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85138-2536
Practice Address - Country:US
Practice Address - Phone:402-215-5025
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-25
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care