Provider Demographics
NPI:1912560491
Name:GRACE AND HOPE HOME HEALTH CARE INC
Entity Type:Organization
Organization Name:GRACE AND HOPE HOME HEALTH CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TETTEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-554-0067
Mailing Address - Street 1:2964 THEMES CT APT 8
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45324-9038
Mailing Address - Country:US
Mailing Address - Phone:937-554-0067
Mailing Address - Fax:
Practice Address - Street 1:2964 THEMES CT APT 8
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45324-9038
Practice Address - Country:US
Practice Address - Phone:937-554-0067
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-19
Last Update Date:2019-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0280104Medicaid