Healthcare Provider Details

I. General information

NPI: 1780450304
Provider Name (Legal Business Name): ZION GRACE HOME CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2023
Last Update Date: 11/27/2023
Certification Date: 11/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 STOOTHOFF DR
NEW HYDE PARK NY
11040-3621
US

IV. Provider business mailing address

16 STOOTHOFF DR
NEW HYDE PARK NY
11040-3621
US

V. Phone/Fax

Practice location:
  • Phone: 646-361-4468
  • Fax:
Mailing address:
  • Phone: 646-361-4468
  • 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 Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: MS. SHU-CHUN S SU
Title or Position: PRESIDENT
Credential:
Phone: 646-361-4468