Healthcare Provider Details

I. General information

NPI: 1053274316
Provider Name (Legal Business Name): GRACEPOINT HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2025
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12839 FRAIZER ST NE
BLAINE MN
55449-3505
US

IV. Provider business mailing address

12839 FRAIZER ST NE
BLAINE MN
55449-3505
US

V. Phone/Fax

Practice location:
  • Phone: 763-339-2524
  • Fax:
Mailing address:
  • Phone: 763-339-2524
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: GRACE A OWOEYE
Title or Position: RN/DIRECTOR
Credential:
Phone: 763-339-2524