Provider Demographics
NPI:1952040487
Name:GREATER GRACE PRIVATE CARE LLC
Entity Type:Organization
Organization Name:GREATER GRACE PRIVATE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHWANA
Authorized Official - Middle Name:LASHON
Authorized Official - Last Name:JAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-310-9479
Mailing Address - Street 1:5425 NEWTON RD STE 4
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31701-7405
Mailing Address - Country:US
Mailing Address - Phone:229-310-9479
Mailing Address - Fax:
Practice Address - Street 1:5425 NEWTON RD STE 4
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-7405
Practice Address - Country:US
Practice Address - Phone:229-310-9479
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-02
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health