Healthcare Provider Details

I. General information

NPI: 1902563349
Provider Name (Legal Business Name): GRACE OF JORDAN HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2021
Last Update Date: 03/17/2022
Certification Date: 03/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 N FRONT ST STE 210
WILMINGTON NC
28401-3908
US

IV. Provider business mailing address

3022 EVENING RD
CASTLE HAYNE NC
28429-5333
US

V. Phone/Fax

Practice location:
  • Phone: 910-540-4250
  • Fax:
Mailing address:
  • Phone: 910-540-4250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY M HALL
Title or Position: CEO
Credential:
Phone: 910-540-4250