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General NPI Number Information
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NPI Number | 1174062525
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Entity Type | Organization
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Legal Business Name | GRACE HAVEN
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Dates
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Enumeration Date | 02/17/2017
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Last Update Date | 02/17/2017
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Provider Practice Location Address
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Address Line | 216 W VOLUSIA AVE
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City | DELAND
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State | FL
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Zip | 32720-6831
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Country | US
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Telephone | 386-847-5414
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Fax |
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Provider Business Mailing Address
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Address Line | 216 W VOLUSIA AVE
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City | DELAND
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State | FL
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Zip | 32720-6831
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Country | US
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Telephone | 386-847-5414
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. SHANEKA DALON MORRIS
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Credential |
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Telephone | 386-847-5414
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 39969574
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License Number State | FL
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