Provider Demographics
NPI:1952139719
Name:GRACE HOME HEALTH LLC
Entity type:Organization
Organization Name:GRACE HOME HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NAJMO
Authorized Official - Middle Name:AHMED
Authorized Official - Last Name:MOHAMED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-364-2160
Mailing Address - Street 1:777 BERRY ST APT 326A
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-2053
Mailing Address - Country:US
Mailing Address - Phone:213-364-2160
Mailing Address - Fax:
Practice Address - Street 1:777 BERRY ST APT 326A
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-2053
Practice Address - Country:US
Practice Address - Phone:213-364-2160
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-23
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health