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General NPI Number Information
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NPI Number | 1245100460
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Entity Type | Organization
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Legal Business Name | GRACE HOMES HEALTH SERVICES LLC
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Dates
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Enumeration Date | 11/11/2025
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Last Update Date | 11/11/2025
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Provider Practice Location Address
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Address Line | 5660 SOUTHWYCK BLVD # 220A
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City | TOLEDO
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State | OH
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Zip | 43614-1566
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Country | US
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Telephone | 513-602-2289
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 441
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City | SYLVANIA
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State | OH
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Zip | 43560-0441
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Country | US
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Telephone | 513-602-2289
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JUDE BUSONG FONGUH
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Credential | PHARMD
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Telephone | 513-602-2289
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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Taxonomy #3
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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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