Healthcare Provider Details

I. General information

NPI: 1992167894
Provider Name (Legal Business Name): GRACE & FAVOR GROUP HOME, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2016
Last Update Date: 03/03/2022
Certification Date: 03/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6519 NW 25TH TER
GAINESVILLE FL
32653-1581
US

IV. Provider business mailing address

PO BOX 141202
GAINESVILLE FL
32614-1202
US

V. Phone/Fax

Practice location:
  • Phone: 352-256-8182
  • Fax:
Mailing address:
  • Phone: 352-256-8182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number233993
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number212625
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: SHRONDA ALLEN
Title or Position: DIRECTOR
Credential:
Phone: 352-256-8182