Healthcare Provider Details

I. General information

NPI: 1467367441
Provider Name (Legal Business Name): GRACE HOME NURSING CARE PROVIDER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2026
Last Update Date: 08/15/2026
Certification Date: 08/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 KILLINGLY ST
JOHNSTON RI
02919-4059
US

IV. Provider business mailing address

655 KILLINGLY ST
JOHNSTON RI
02919-4059
US

V. Phone/Fax

Practice location:
  • Phone: 401-472-9853
  • Fax: 401-472-9852
Mailing address:
  • Phone: 401-472-9853
  • Fax: 401-472-9852

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: YOHANNY MERCEDES
Title or Position: ADMINISTRATOR
Credential:
Phone: 401-472-9853