MEDICARE: GRACE'S SUPPORT SERVICES, 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	171M00000X	Case Manager/Care Coordinator

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538614540
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRACE'S SUPPORT SERVICES, LLC

Provider Business Mailing Address
First Line	:	15508 WILLET CT
Second Line	:
City	:	MASCOTTE
State	:	FL
Zip	:	34753-9102
Country	:	US
Telephone Number	:	352-255-6458
Fax Number	:

Provider Business Practice Location Address
First Line	:	15508 WILLET CT
Second Line	:
City	:	MASCOTTE
State	:	FL
Zip	:	34753-9102
Country	:	US
Telephone Number	:	352-255-6458
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. NABUCHI ANDERSON
Credential	:
Telephone Number	:	352-255-6458

Provider Enumeration Date	:	08/19/2016
Last Update Date	:	08/19/2016

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Directions to “GRACE'S SUPPORT SERVICES, LLC ” Practice Location

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