Healthcare Provider Details

I. General information

NPI: 1053054809
Provider Name (Legal Business Name): LOVING GRACE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2022
Last Update Date: 04/19/2022
Certification Date: 04/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2605 STIRRUP LN
DALZELL SC
29040-9412
US

IV. Provider business mailing address

2605 STIRRUP LN
DALZELL SC
29040-9412
US

V. Phone/Fax

Practice location:
  • Phone: 803-494-7724
  • Fax:
Mailing address:
  • Phone: 803-494-7724
  • Fax:

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: FAYSHAWN JULIEN
Title or Position: RN/ OWNER
Credential: RN
Phone: 803-464-1548