Provider Demographics
NPI:1700399417
Name:GRACEWOOD HOME HEALTH AGENCY LLC
Entity Type:Organization
Organization Name:GRACEWOOD HOME HEALTH AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:BEACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-460-8494
Mailing Address - Street 1:1281 E MAGNOLIA ST UNIT D-107
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-4796
Mailing Address - Country:US
Mailing Address - Phone:970-460-8494
Mailing Address - Fax:970-493-2211
Practice Address - Street 1:107 S BLUERIDGE CT
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-8808
Practice Address - Country:US
Practice Address - Phone:970-460-8494
Practice Address - Fax:970-493-2211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-16
Last Update Date:2017-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty