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General NPI Number Information
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NPI Number | 1194077065
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Entity Type | Organization
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Legal Business Name | GRACE REGIONAL MEDICAL CARE L.L.C.
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Dates
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Enumeration Date | 10/02/2012
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Last Update Date | 10/02/2012
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Provider Practice Location Address
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Address Line | 409 TAPESTRY PARK DR UNIT 826
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City | CHESAPEAKE
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State | VA
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Zip | 23320-5060
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Country | US
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Telephone | 757-502-3402
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1507
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City | CHESAPEAKE
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State | VA
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Zip | 23327-1507
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Country | US
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Telephone | 757-502-3402
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MS. CHACON DRAKEFORD
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Credential | RN
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Telephone | 757-502-3402
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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 | 0001212360
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License Number State | VA
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