Healthcare Provider Details

I. General information

NPI: 1861488751
Provider Name (Legal Business Name): GRACE NURSING HOME INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2005
Last Update Date: 07/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9725 GRACE LN
CLINTON LA
70722-4925
US

IV. Provider business mailing address

PO BOX 945
CLINTON LA
70722-0945
US

V. Phone/Fax

Practice location:
  • Phone: 225-683-8533
  • Fax: 225-683-3222
Mailing address:
  • Phone: 225-683-8533
  • Fax: 225-683-3222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number370
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number370
License Number StateLA

VIII. Authorized Official

Name: MR. SIDNEY D SAINT
Title or Position: ADMINISTRATOR
Credential: NFA
Phone: 225-683-8533