Healthcare Provider Details

I. General information

NPI: 1104757509
Provider Name (Legal Business Name): GRACE HEALS AT HOME L.L.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8350 S 86TH AVE APT 216
JUSTICE IL
60458-1814
US

IV. Provider business mailing address

8350 S 86TH AVE APT 216
JUSTICE IL
60458-1814
US

V. Phone/Fax

Practice location:
  • Phone: 215-987-8550
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINA OLIVIA GAINEY
Title or Position: CEO
Credential:
Phone: 215-987-8550