Healthcare Provider Details

I. General information

NPI: 1326327024
Provider Name (Legal Business Name): GOD'S GRACE L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2011
Last Update Date: 08/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6708 ROBBINS AVE
SAINT LOUIS MO
63133-1623
US

IV. Provider business mailing address

224 N HIGHWAY 67 STE 311
FLORISSANT MO
63031-5904
US

V. Phone/Fax

Practice location:
  • Phone: 314-803-8364
  • Fax:
Mailing address:
  • Phone: 314-803-8364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MRS. TRACY DE SHA
Title or Position: OWNER/MANAGER
Credential:
Phone: 314-803-8364