Healthcare Provider Details

I. General information

NPI: 1760002018
Provider Name (Legal Business Name): GRACE HOME HEALTHCARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2020
Last Update Date: 05/14/2020
Certification Date: 05/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 E MAIN ST STE 5
ALBERT LEA MN
56007-2982
US

IV. Provider business mailing address

216 E MAIN ST STE 5
ALBERT LEA MN
56007-2982
US

V. Phone/Fax

Practice location:
  • Phone: 507-369-5370
  • Fax: 507-369-5983
Mailing address:
  • Phone: 507-369-5370
  • Fax: 507-369-5983

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: TODD COUGHLIN
Title or Position: ADMINISTRATOR
Credential:
Phone: 507-402-5575