MEDICARE: GRACE MAXWELL

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	372600000X	Adult Companion
2	3747P1801X	Personal Care Attendant
3	372500000X	Chore Provider

General Provider Information

NPI Number	:	1811702384
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRACE MAXWELL

Provider Business Mailing Address
First Line	:	109 GOLD STRIKE DR APT 2
Second Line	:
City	:	NORFOLK
State	:	NE
Zip	:	68701-2959
Country	:	US
Telephone Number	:	402-340-9961
Fax Number	:

Provider Business Practice Location Address
First Line	:	109 GOLD STRIKE DR APT 2
Second Line	:
City	:	NORFOLK
State	:	NE
Zip	:	68701-2959
Country	:	US
Telephone Number	:	402-340-9961
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/11/2025
Last Update Date	:	02/11/2025

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Directions to “ GRACE MAXWELL ” Practice Location

Language	Start Address	Practice Location

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