MEDICARE: GRACE HME AND SUPPLIES LLC

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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1215692223
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRACE HME AND SUPPLIES LLC

Provider Business Mailing Address
First Line	:	2590 FERGUSON RD APT 9
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45238-2457
Country	:	US
Telephone Number	:	513-485-8642
Fax Number	:

Provider Business Practice Location Address
First Line	:	2590 FERGUSON RD APT 9
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45238-2457
Country	:	US
Telephone Number	:	513-485-8642
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MEKA TERRY
Credential	:
Telephone Number	:	513-485-8642

Provider Enumeration Date	:	11/04/2021
Last Update Date	:	02/20/2023

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