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General NPI Number Information
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NPI Number | 1215642509
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Entity Type | Organization
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Legal Business Name | LOVING GRACE HOME CARE, LLC
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Dates
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Enumeration Date | 01/20/2023
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Last Update Date | 01/20/2023
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Provider Practice Location Address
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Address Line | 709 LAKELAND ST
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City | FAYETTEVILLE
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State | NC
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Zip | 28301-4243
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Country | US
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Telephone | 910-339-0452
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2463
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City | DUNN
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State | NC
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Zip | 28335-2463
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Country | US
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Telephone | 910-658-2548
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | SHERRON VANCLEAVE
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Credential |
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Telephone | 910-339-0452
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number |
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License Number State |
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