MEDICARE: GRACE HEALTH SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	HC3099	NC

General Provider Information

NPI Number	:	1205962362
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRACE HEALTH SERVICES

Provider Business Mailing Address
First Line	:	3000 HIGHWOODS BLVD
Second Line	:	SUITE 140
City	:	RALEIGH
State	:	NC
Zip	:	27604-1027
Country	:	US
Telephone Number	:	919-872-3848
Fax Number	:	919-872-3813

Provider Business Practice Location Address
First Line	:	3000 HIGHWOODS BLVD
Second Line	:	SUITE 140
City	:	RALEIGH
State	:	NC
Zip	:	27604-1027
Country	:	US
Telephone Number	:	919-872-3848
Fax Number	:	919-872-3813

Authorized Official
Title or Position	:	BUSINESS MANAGER
Name	:	MICHEAL OKESANYA
Credential	:
Telephone Number	:	919-872-3848

Provider Enumeration Date	:	02/25/2007
Last Update Date	:	08/22/2020

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