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General NPI Number Information
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NPI Number | 1336487347
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Entity Type | Organization
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Legal Business Name | GRACE HOSPICE OF WISCONSIN, LLC
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Dates
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Enumeration Date | 01/25/2013
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Last Update Date | 10/16/2025
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Provider Practice Location Address
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Address Line | 2514 S 102ND ST STE 276
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City | WEST ALLIS
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State | WI
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Zip | 53227-2142
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Country | US
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Telephone | 414-395-8650
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Fax | 855-845-1846
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Provider Business Mailing Address
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Address Line | 103 FORREST CROSSING BLVD STE 101
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City | FRANKLIN
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State | TN
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Zip | 37064-5454
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Country | US
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Telephone | 615-430-2929
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Fax | 855-618-6652
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Authorized Official
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Title or Position | CEO
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Name | ANNA-GENE O'NEAL
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Credential |
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Telephone | 617-596-5278
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number |
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License Number State | WI
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