Provider Demographics
NPI:1699040683
Name:SAVING GRACE OF OHIO, LLC
Entity Type:Organization
Organization Name:SAVING GRACE OF OHIO, LLC
Other - Org Name:SAVING GRACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-433-9997
Mailing Address - Street 1:300 N MAYO TRL STE 7
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41501-1563
Mailing Address - Country:US
Mailing Address - Phone:606-433-9997
Mailing Address - Fax:
Practice Address - Street 1:300 N MAYO TRL STE 7
Practice Address - Street 2:
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-1563
Practice Address - Country:US
Practice Address - Phone:606-433-9997
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAVING GRACE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-03-09
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY6429280001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY6429280001OtherMEDICARE PTAN