Healthcare Provider Details

I. General information

NPI: 1598430100
Provider Name (Legal Business Name): CARING HEARTS OF GRACE HOMECARE AGENCY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2021
Last Update Date: 12/19/2022
Certification Date: 12/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

294 CHURCH ST N
CONCORD NC
28025-4571
US

IV. Provider business mailing address

1085 HEARTH LN SW
CONCORD NC
28025-8809
US

V. Phone/Fax

Practice location:
  • Phone: 980-237-8845
  • Fax: 980-237-8845
Mailing address:
  • Phone: 980-237-8845
  • Fax: 980-237-8845

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 Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: LEQUITHA SIMMONS
Title or Position: OWNER
Credential:
Phone: 980-334-5367