Healthcare Provider Details

I. General information

NPI: 1396677993
Provider Name (Legal Business Name): GRACE KEPT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2026
Last Update Date: 05/30/2026
Certification Date: 05/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 BATTY WAY
SUMTER SC
29154-8155
US

IV. Provider business mailing address

560 BATTY WAY
SUMTER SC
29154-8155
US

V. Phone/Fax

Practice location:
  • Phone: 803-757-0076
  • Fax: 803-403-0351
Mailing address:
  • Phone: 803-757-0076
  • Fax: 803-403-0351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: DARNELLA JACKSON
Title or Position: LPN/ADMINISTRATOR
Credential: JACKSON
Phone: 839-333-2565