Healthcare Provider Details

I. General information

NPI: 1205068319
Provider Name (Legal Business Name): GRACE HOME CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2009
Last Update Date: 08/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9005 OVERLOOK BLVD SUITE 236
BRENTWOOD TN
37027-5269
US

IV. Provider business mailing address

9005 OVERLOOK BLVD SUITE 236
BRENTWOOD TN
37027-5269
US

V. Phone/Fax

Practice location:
  • Phone: 615-236-1482
  • Fax: 615-236-1483
Mailing address:
  • Phone: 615-236-1482
  • Fax: 615-236-1483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number1000000005158
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number1000000005158
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number1000000005158
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number1000000005158
License Number StateTN
# 5
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number1000000005158
License Number StateTN

VIII. Authorized Official

Name: MS. DEBORAH UGWA
Title or Position: OWNER/EXECUTIVE DIRECTOR
Credential: RN
Phone: 615-236-1482