Healthcare Provider Details

I. General information

NPI: 1316527633
Provider Name (Legal Business Name): GRACE HOME REHAB SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2021
Last Update Date: 04/11/2021
Certification Date: 04/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2620 S UNIVERSITY DR APT 307
DAVIE FL
33328-1472
US

IV. Provider business mailing address

2620 S UNIVERSITY DR APT 307
DAVIE FL
33328-1472
US

V. Phone/Fax

Practice location:
  • Phone: 732-725-7040
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. DANIEL BOTROS
Title or Position: OWNER
Credential: DPT
Phone: 732-725-7040