Healthcare Provider Details

I. General information

NPI: 1588418396
Provider Name (Legal Business Name): GRACE HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2024
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

749 N SUNRISE DR
ROMEOVILLE IL
60446-5801
US

IV. Provider business mailing address

749 N SUNRISE DR
ROMEOVILLE IL
60446-5801
US

V. Phone/Fax

Practice location:
  • Phone: 815-995-4011
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. BRIDGET DUAH
Title or Position: AGENT ADMINISTRATOR
Credential:
Phone: 815-995-4011