Healthcare Provider Details

I. General information

NPI: 1023702248
Provider Name (Legal Business Name): SONS OF GRACE CARE SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2023
Last Update Date: 06/08/2023
Certification Date: 06/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6470 LITHOPOLIS RD STE A
CARROLL OH
43112-9680
US

IV. Provider business mailing address

6470 LITHOPOLIS RD STE A
CARROLL OH
43112-9680
US

V. Phone/Fax

Practice location:
  • Phone: 614-816-6006
  • Fax:
Mailing address:
  • Phone: 614-816-6006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: BRIAN S KAPFUNDE
Title or Position: OWNER
Credential:
Phone: 614-816-6006