=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205962362
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GRACE HEALTH SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/25/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3000 HIGHWOODS BLVD SUITE 140
-----------------------------------------------------
City | RALEIGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27604-1027
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-872-3848
-----------------------------------------------------
Fax | 919-872-3813
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3000 HIGHWOODS BLVD SUITE 140
-----------------------------------------------------
City | RALEIGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27604-1027
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-872-3848
-----------------------------------------------------
Fax | 919-872-3813
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BUSINESS MANAGER
-----------------------------------------------------
Name | MICHEAL OKESANYA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 919-872-3848
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | HC3099
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------