Provider Demographics
NPI:1619732070
Name:GRACEALLIANCE LLC
Entity Type:Organization
Organization Name:GRACEALLIANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CANDI
Authorized Official - Middle Name:
Authorized Official - Last Name:CANSLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-972-2463
Mailing Address - Street 1:12282 SCOTTS MILL DR
Mailing Address - Street 2:
Mailing Address - City:BRISTOW
Mailing Address - State:VA
Mailing Address - Zip Code:20136-1914
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9720 CAPITAL CT STE 401A
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-2052
Practice Address - Country:US
Practice Address - Phone:703-940-5946
Practice Address - Fax:703-650-1972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-15
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care