Provider Demographics
NPI:1649043548
Name:THE GRACE SERVICES LLC
Entity type:Organization
Organization Name:THE GRACE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:EDNOCK
Authorized Official - Middle Name:NTUNGUMU
Authorized Official - Last Name:KHONDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-352-8862
Mailing Address - Street 1:10 COLUMBIA ST UNIT 2
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-4802
Mailing Address - Country:US
Mailing Address - Phone:207-352-8862
Mailing Address - Fax:
Practice Address - Street 1:10 COLUMBIA ST UNIT 2
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-4802
Practice Address - Country:US
Practice Address - Phone:207-352-8862
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-01
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No253Z00000XAgenciesIn Home Supportive Care