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NPI Code Detail

MEDICARE: GOD'S GRACE L.L.C.

MEDICARE: GOD'S GRACE L.L.C.
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
1251E00000XHome Health Agency
2253Z00000XIn Home Supportive Care Agency
3343900000XNon-emergency Medical Transport (VAN)

General Provider Information

NPI Number : 1326327024
Entity Type Code : Organization
Provider Name (Legal Business Name) : GOD'S GRACE L.L.C.
Provider Business Mailing Address
First Line : 224 N HIGHWAY 67 STE 311
Second Line :
City : FLORISSANT
State : MO
Zip : 63031-5904
Country : US
Telephone Number : 314-803-8364
Fax Number :
Provider Business Practice Location Address
First Line : 6708 ROBBINS AVE
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63133-1623
Country : US
Telephone Number : 314-803-8364
Fax Number :
Authorized Official
Title or Position : OWNER/MANAGER
Name : MRS. TRACY DE SHA
Credential :
Telephone Number : 314-803-8364
Provider Enumeration Date : 08/11/2011
Last Update Date : 08/11/2011

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Directions to “GOD'S GRACE L.L.C. ” Practice Location

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