Provider Demographics
NPI:1861488751
Name:GRACE NURSING HOME INC
Entity Type:Organization
Organization Name:GRACE NURSING HOME INC
Other - Org Name:GRACE HEALTH AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SIDNEY
Authorized Official - Middle Name:D
Authorized Official - Last Name:SAINT
Authorized Official - Suffix:
Authorized Official - Credentials:NFA
Authorized Official - Phone:225-683-8533
Mailing Address - Street 1:PO BOX 945
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:LA
Mailing Address - Zip Code:70722-0945
Mailing Address - Country:US
Mailing Address - Phone:225-683-8533
Mailing Address - Fax:225-683-3222
Practice Address - Street 1:9725 GRACE LN
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:LA
Practice Address - Zip Code:70722-4925
Practice Address - Country:US
Practice Address - Phone:225-683-8533
Practice Address - Fax:225-683-3222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-26
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA370313M00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1515094Medicaid
LA33857OtherBLUE CROSS BLUE SHIELD LA
LA195258Medicare ID - Type Unspecified