Healthcare Provider Details

I. General information

NPI: 1710670047
Provider Name (Legal Business Name): GRACE TOTAL HOMECARE SERVICES LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2023
Last Update Date: 06/05/2024
Certification Date: 06/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 STATE ST UNIT 202L
HACKENSACK NJ
07601-5429
US

IV. Provider business mailing address

11 STATE ST UNIT 202L
HACKENSACK NJ
07601-5429
US

V. Phone/Fax

Practice location:
  • Phone: 201-402-9550
  • Fax: 201-402-9549
Mailing address:
  • Phone: 201-402-9550
  • Fax: 201-407-9549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: RAYFRED JOSEPHINE ANSAH
Title or Position: OWNER
Credential: CEO/RN
Phone: 201-779-9632