Provider Demographics
NPI:1780399923
Name:GRACE EBOH HOME CARE LLC.
Entity type:Organization
Organization Name:GRACE EBOH HOME CARE LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:M WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-363-2637
Mailing Address - Street 1:PO BOX 1718
Mailing Address - Street 2:
Mailing Address - City:HARDWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31034-1718
Mailing Address - Country:US
Mailing Address - Phone:478-363-2637
Mailing Address - Fax:
Practice Address - Street 1:150 SESSIONS DR
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-2317
Practice Address - Country:US
Practice Address - Phone:478-363-2637
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health