Healthcare Provider Details

I. General information

NPI: 1932611837
Provider Name (Legal Business Name): GRACE GIVERS HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2017
Last Update Date: 07/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 RECTOR AVE
CROSSVILLE TN
38555-4482
US

IV. Provider business mailing address

3888 PEAVINE RD
CROSSVILLE TN
38571-7921
US

V. Phone/Fax

Practice location:
  • Phone: 931-337-0890
  • Fax:
Mailing address:
  • Phone: 931-337-0890
  • Fax: 931-337-0893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: KELLI G TIPTON
Title or Position: MEMBER,GRACE GIVERS HOME CARE LLC
Credential:
Phone: 931-337-0890