Provider Demographics
NPI:1851744049
Name:SWEET GRACE HOME HEALTH AGENCY, LLC
Entity Type:Organization
Organization Name:SWEET GRACE HOME HEALTH AGENCY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BEAMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-934-6000
Mailing Address - Street 1:112 W WASHINGTON ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-5246
Mailing Address - Country:US
Mailing Address - Phone:757-934-6000
Mailing Address - Fax:757-934-6001
Practice Address - Street 1:112 W WASHINGTON ST
Practice Address - Street 2:SUITE 302
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-5246
Practice Address - Country:US
Practice Address - Phone:757-934-6000
Practice Address - Fax:757-934-6001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-22
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO-171481251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health