Provider Demographics
NPI:1558020008
Name:OUR HOME OF GRACE HOME CARE LLC
Entity Type:Organization
Organization Name:OUR HOME OF GRACE HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAKESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-569-0423
Mailing Address - Street 1:4006 TRALEE RD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32309-2821
Mailing Address - Country:US
Mailing Address - Phone:229-569-0423
Mailing Address - Fax:850-765-1132
Practice Address - Street 1:2940 E PARK AVE UNIT 2-J
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-3446
Practice Address - Country:US
Practice Address - Phone:229-569-0423
Practice Address - Fax:850-765-1132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-13
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health