Provider Demographics
NPI:1558974261
Name:CRACE, RANDY BROOKS II
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:BROOKS
Last Name:CRACE
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2484 BILLS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:25213-9415
Mailing Address - Country:US
Mailing Address - Phone:304-593-0705
Mailing Address - Fax:
Practice Address - Street 1:2484 BILLS CREEK RD
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:WV
Practice Address - Zip Code:25213-9415
Practice Address - Country:US
Practice Address - Phone:304-593-0705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-24
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant