Provider Demographics
NPI:1184933186
Name:GRACE PERSONAL CARE HOME LIVING INC
Entity type:Organization
Organization Name:GRACE PERSONAL CARE HOME LIVING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DOTSE
Authorized Official - Middle Name:
Authorized Official - Last Name:OYAREBU
Authorized Official - Suffix:
Authorized Official - Credentials:BACHELOR OF SOCIAL W
Authorized Official - Phone:770-477-2541
Mailing Address - Street 1:2625 NEW HAVEN DR
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-2737
Mailing Address - Country:US
Mailing Address - Phone:770-477-2541
Mailing Address - Fax:770-477-2541
Practice Address - Street 1:2625 NEW HAVEN DR
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-2737
Practice Address - Country:US
Practice Address - Phone:770-477-2541
Practice Address - Fax:770-477-2541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-25
Last Update Date:2010-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA031-01-132-1311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home