Provider Demographics
NPI:1265791776
Name:GRACE HOSPICE OF VIRGINIA, LLC
Entity type:Organization
Organization Name:GRACE HOSPICE OF VIRGINIA, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:VASEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-824-6000
Mailing Address - Street 1:500 KIRTS BLVD
Mailing Address - Street 2:ATTN: CREDENTIALING DEPARTMENT
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-4134
Mailing Address - Country:US
Mailing Address - Phone:248-824-6000
Mailing Address - Fax:855-618-6655
Practice Address - Street 1:236 CLEARFIELD AVE
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-1893
Practice Address - Country:US
Practice Address - Phone:757-561-2880
Practice Address - Fax:877-473-8161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-04
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1265791776Medicaid