Provider Demographics
NPI:1598006124
Name:AGING GRACE SUPPORTS COORDINATION
Entity Type:Organization
Organization Name:AGING GRACE SUPPORTS COORDINATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KETTY
Authorized Official - Middle Name:
Authorized Official - Last Name:POINTE JOUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-779-8526
Mailing Address - Street 1:404 DAVISVILLE RD STE 3
Mailing Address - Street 2:
Mailing Address - City:WILLOW GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19090-2727
Mailing Address - Country:US
Mailing Address - Phone:215-779-8526
Mailing Address - Fax:
Practice Address - Street 1:404 DAVISVILLE RD STE 3
Practice Address - Street 2:
Practice Address - City:WILLOW GROVE
Practice Address - State:PA
Practice Address - Zip Code:19090-2727
Practice Address - Country:US
Practice Address - Phone:215-779-8526
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-06
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management