Healthcare Provider Details

I. General information

NPI: 1144031626
Provider Name (Legal Business Name): GRACE HOUSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2025
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1730 LEWIS AVE
LAS VEGAS NV
89101-5233
US

IV. Provider business mailing address

1730 LEWIS AVE
LAS VEGAS NV
89101-5233
US

V. Phone/Fax

Practice location:
  • Phone: 424-299-0643
  • Fax:
Mailing address:
  • Phone: 424-299-0643
  • Fax:

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 Code372500000X
TaxonomyChore Provider
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: RAY JUNG
Title or Position: BOARD MEMBER
Credential:
Phone: 424-299-0643