Healthcare Provider Details

I. General information

NPI: 1538073937
Provider Name (Legal Business Name): GRACE IN HEALING HOME HEATH CARE AGENCY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 BUSH RIVER RD STE 3B
COLUMBIA SC
29210-5662
US

IV. Provider business mailing address

806 HILLCREST DR
JOHNSTON SC
29832-1327
US

V. Phone/Fax

Practice location:
  • Phone: 803-480-0356
  • Fax:
Mailing address:
  • Phone: 803-480-0356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: LAKYSHA JONES
Title or Position: OWNER
Credential:
Phone: 803-480-0356