Healthcare Provider Details

I. General information

NPI: 1679088819
Provider Name (Legal Business Name): INSPIRED GRACE HEALTHCARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2017
Last Update Date: 09/19/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1051 E MAIN ST STE 212
EAST DUNDEE IL
60118-2455
US

IV. Provider business mailing address

1051 E MAIN ST STE 212
EAST DUNDEE IL
60118-2455
US

V. Phone/Fax

Practice location:
  • Phone: 224-484-0596
  • Fax:
Mailing address:
  • Phone: 224-484-0596
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number4000567
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number3001606
License Number StateIL

VIII. Authorized Official

Name: JAMES IDOWU
Title or Position: PRESIDENT
Credential:
Phone: 224-484-0596