Healthcare Provider Details

I. General information

NPI: 1033708961
Provider Name (Legal Business Name): SARAH GRACE HOME CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2021
Last Update Date: 01/14/2021
Certification Date: 01/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2835 CHAPMAN CT
MARIETTA GA
30066-3673
US

IV. Provider business mailing address

2835 CHAPMAN CT
MARIETTA GA
30066-3673
US

V. Phone/Fax

Practice location:
  • Phone: 678-754-3533
  • Fax:
Mailing address:
  • Phone: 678-754-3533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: ALLAN GITAU
Title or Position: DIRECTOR
Credential: RN
Phone: 678-754-3533