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General NPI Number Information
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NPI Number | 1215395900
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Entity Type | Organization
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Legal Business Name | GRACE SUPPORTIVE LIVING SERVICES LLC
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Dates
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Enumeration Date | 02/09/2016
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Last Update Date | 02/18/2016
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Provider Practice Location Address
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Address Line | 3350 RIVERWOOD PKWY SE 1900
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City | ATLANTA
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State | GA
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Zip | 30339-6401
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Country | US
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Telephone | 770-984-5388
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Fax |
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Provider Business Mailing Address
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Address Line | 3350 RIVERWOOD PKWY SE 1900
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City | ATLANTA
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State | GA
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Zip | 30339-6401
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Country | US
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Telephone | 770-984-5388
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Fax |
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Authorized Official
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Title or Position | OWNER/LICENSE NURSE
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Name | MS. SAMARA L ROBERTSON
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Credential | LPN
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Telephone | 770-984-5388
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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 | LPN0089404
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License Number State | GA
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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 |
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License Number State |
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