Healthcare Provider Details

I. General information

NPI: 1831007996
Provider Name (Legal Business Name): PURE GRACE HOMECARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4246 FORGE RD
PERRY HALL MD
21128-9510
US

IV. Provider business mailing address

4246 FORGE RD
PERRY HALL MD
21128-9510
US

V. Phone/Fax

Practice location:
  • Phone: 717-881-0575
  • Fax:
Mailing address:
  • Phone: 717-881-0575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: MS. STACI BEASLEY
Title or Position: CEO
Credential:
Phone: 717-881-0575