Healthcare Provider Details

I. General information

NPI: 1033039771
Provider Name (Legal Business Name): GUARDIAN GRACE HOME CARE SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 SULGRAVE CT
STERLING VA
20165-6406
US

IV. Provider business mailing address

123 SULGRAVE CT
STERLING VA
20165-6406
US

V. Phone/Fax

Practice location:
  • Phone: 571-682-4398
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: MR. KOFI OPOKU
Title or Position: OWNER
Credential:
Phone: 571-474-8106