Provider Demographics
NPI:1295755130
Name:GRACE MEDICAL LLC
Entity type:Organization
Organization Name:GRACE MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:LORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-909-3722
Mailing Address - Street 1:711 N MAIN ST
Mailing Address - Street 2:UNIT 13
Mailing Address - City:PLEASANTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08232-1590
Mailing Address - Country:US
Mailing Address - Phone:609-909-3722
Mailing Address - Fax:609-909-2861
Practice Address - Street 1:711 N MAIN ST
Practice Address - Street 2:UNIT 13
Practice Address - City:PLEASANTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08232-1590
Practice Address - Country:US
Practice Address - Phone:609-909-3722
Practice Address - Fax:609-909-2861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies