Healthcare Provider Details

I. General information

NPI: 1487245056
Provider Name (Legal Business Name): COMGRACE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2021
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

838 GREEN ST STE 202
ISELIN NJ
08830-2994
US

IV. Provider business mailing address

838 GREEN ST STE 202
ISELIN NJ
08830-2994
US

V. Phone/Fax

Practice location:
  • Phone: 732-710-0253
  • Fax: 732-358-0452
Mailing address:
  • Phone: 732-710-0253
  • Fax: 732-358-0452

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: JOHNSON ADEYEMI OLOWE
Title or Position: ADMINISTRATOR
Credential:
Phone: 732-710-0253