Provider Demographics
NPI:1598167652
Name:GRACE PROVIDERS HOME HEALTH CARE INC.
Entity Type:Organization
Organization Name:GRACE PROVIDERS HOME HEALTH CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:H
Authorized Official - Last Name:MAINGUY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-770-9930
Mailing Address - Street 1:3931 AVION PARK CT UNIT C161232
Mailing Address - Street 2:
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20151-3982
Mailing Address - Country:US
Mailing Address - Phone:703-596-4544
Mailing Address - Fax:
Practice Address - Street 1:3931 AVION PARK CT UNIT C161232
Practice Address - Street 2:
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151-3982
Practice Address - Country:US
Practice Address - Phone:703-596-4544
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-20
Last Update Date:2014-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO-151156251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health