Healthcare Provider Details

I. General information

NPI: 1043100159
Provider Name (Legal Business Name): LADY GRACE STORES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2025
Last Update Date: 07/09/2025
Certification Date: 07/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 CONCORD ST # 100
WILMINGTON MA
01887-2196
US

IV. Provider business mailing address

375 N WEST ST
WESTERVILLE OH
43082-1400
US

V. Phone/Fax

Practice location:
  • Phone: 800-892-4044
  • Fax:
Mailing address:
  • Phone: 614-901-2226
  • Fax: 614-901-2868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: RACHEL MAZUR
Title or Position: CEO
Credential:
Phone: 614-901-2109