Provider Demographics
NPI:1669861084
Name:GRACE HOME HEALTH CARE
Entity Type:Organization
Organization Name:GRACE HOME HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:HAMDI
Authorized Official - Middle Name:SADE
Authorized Official - Last Name:AFYARE
Authorized Official - Suffix:
Authorized Official - Credentials:N/N
Authorized Official - Phone:612-354-3823
Mailing Address - Street 1:1520 E 66TH ST STE 1
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55423-2675
Mailing Address - Country:US
Mailing Address - Phone:612-354-3823
Mailing Address - Fax:
Practice Address - Street 1:1520 E 66TH ST STE 1
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55423-2675
Practice Address - Country:US
Practice Address - Phone:612-354-3823
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-22
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN368030251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNA799122200OtherMHCP WAIVER UMP #
MNA897667200OtherMHCP UMPI