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General NPI Number Information
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NPI Number | 1164890836
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Entity Type | Organization
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Legal Business Name | GRACE'S SENIOR CARE SERVICES
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Dates
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Enumeration Date | 09/10/2015
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Last Update Date | 09/10/2015
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Provider Practice Location Address
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Address Line | 8150 FOXDALE DR
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City | JACKSONVILLE
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State | FL
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Zip | 32210-4695
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Country | US
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Telephone | 904-495-8563
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Fax |
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Provider Business Mailing Address
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Address Line | 8150 FOXDALE DR
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City | JACKSONVILLE
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State | FL
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Zip | 32210-4695
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Country | US
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Telephone | 904-495-8563
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Fax |
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Authorized Official
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Title or Position | OWNE
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Name | TELISHA GRANT
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Credential |
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Telephone | 904-495-8463
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 233507
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License Number State | FL
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