Healthcare Provider Details

I. General information

NPI: 1538922570
Provider Name (Legal Business Name): GRACE GENERATION HOMECARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2024
Last Update Date: 02/02/2024
Certification Date: 02/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

423 SW 8TH ST
DES MOINES IA
50309-4615
US

IV. Provider business mailing address

2752 HOLCOMB AVE
DES MOINES IA
50310-5559
US

V. Phone/Fax

Practice location:
  • Phone: 515-200-9559
  • Fax:
Mailing address:
  • Phone: 515-200-9559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code385HR2055X
TaxonomyChild Mental Illness Respite Care
License Number
License Number StateNULL
# 6
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: CYRUS WESSEH GUEH SR.
Title or Position: CHIEF FINACIAL OFFICAL
Credential:
Phone: 515-200-9559