Healthcare Provider Details

I. General information

NPI: 1528614674
Provider Name (Legal Business Name): GRACE HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2019
Last Update Date: 03/30/2023
Certification Date: 03/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

188 ONVILLE RD
STAFFORD VA
22556-3805
US

IV. Provider business mailing address

3 SUTTON CT
STAFFORD VA
22554-8335
US

V. Phone/Fax

Practice location:
  • Phone: 540-779-1648
  • Fax: 540-602-7062
Mailing address:
  • Phone: 360-970-7708
  • Fax: 703-441-2574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: COLLETTE F NGANTE
Title or Position: OWNER OF ENTITY
Credential: PMHNP-BC
Phone: 360-970-7708