Provider Demographics
NPI:1558934828
Name:ALL GRACE FAMILY HOME, LLC.
Entity Type:Organization
Organization Name:ALL GRACE FAMILY HOME, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LACRESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:CALDWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-602-7091
Mailing Address - Street 1:914 EDGEWATER DR
Mailing Address - Street 2:
Mailing Address - City:EUSTIS
Mailing Address - State:FL
Mailing Address - Zip Code:32726-2690
Mailing Address - Country:US
Mailing Address - Phone:352-602-7091
Mailing Address - Fax:352-557-8562
Practice Address - Street 1:914 EDGEWATER DR
Practice Address - Street 2:
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32726-2690
Practice Address - Country:US
Practice Address - Phone:352-602-7091
Practice Address - Fax:352-557-8562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-23
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care