Healthcare Provider Details

I. General information

NPI: 1437877537
Provider Name (Legal Business Name): GRACE HOME HEALTHCARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2022
Last Update Date: 08/17/2022
Certification Date: 08/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11059 E BETHANY DR STE 104
AURORA CO
80014-2617
US

IV. Provider business mailing address

11059 E BETHANY DR STE 104
AURORA CO
80014-2617
US

V. Phone/Fax

Practice location:
  • Phone: 317-629-7620
  • Fax:
Mailing address:
  • Phone: 317-629-7620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: EMMANUEL KOLLEH
Title or Position: MANAGER
Credential:
Phone: 317-629-7620