=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073482303
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GRACE CARE NONEMERGENCY, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/04/2025
-----------------------------------------------------
Last Update Date | 11/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1417 56TH ST,
-----------------------------------------------------
City | DES MOINES
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50311
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 515-528-4969
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1417 56TH ST,
-----------------------------------------------------
City | DES MOINES
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50311
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 515-528-4969
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CNA WITH CERTIFICATIONS ONLY NO LIC
-----------------------------------------------------
Name | MARANATHA LAZARO
-----------------------------------------------------
Credential | CMA/CNA
-----------------------------------------------------
Telephone | 515-528-4969
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 376K00000X
-----------------------------------------------------
Taxonomy Name | Nurse's Aide
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------