Healthcare Provider Details

I. General information

NPI: 1972753192
Provider Name (Legal Business Name): GRACE HEALTHCARE MANAGEMENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2008
Last Update Date: 10/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 PAUL MAILLARD ROAD
LULING LA
70070
US

IV. Provider business mailing address

P.O. BOX 2604
LAPLACE LA
70069
US

V. Phone/Fax

Practice location:
  • Phone: 985-785-5233
  • Fax: 985-785-5181
Mailing address:
  • Phone: 985-785-5233
  • Fax: 985-785-5181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License Number
License Number State

VIII. Authorized Official

Name: MRS. LATRENDA C BARNES
Title or Position: ADMINISTRATOR
Credential:
Phone: 985-785-5233