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General NPI Number Information
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NPI Number | 1174204119
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Entity Type | Organization
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Legal Business Name | GRACE HOME HEALTH CARE LLC
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Dates
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Enumeration Date | 07/31/2023
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Last Update Date | 07/31/2023
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Provider Practice Location Address
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Address Line | 3000 KNIGHT ST STE 204
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City | SHREVEPORT
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State | LA
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Zip | 71105-2573
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Country | US
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Telephone | 318-489-1459
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Fax |
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Provider Business Mailing Address
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Address Line | 5303 E TEXAS ST LOT 89
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City | BOSSIER CITY
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State | LA
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Zip | 71111-6958
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Country | US
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Telephone | 318-489-1459
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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. LATASHA NICOLE WALKER
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Credential |
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Telephone | 318-489-1459
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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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