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General NPI Number Information
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NPI Number | 1376365460
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Entity Type | Organization
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Legal Business Name | GRACE HAVEN HOME CARE LLC
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Dates
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Enumeration Date | 10/29/2024
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Last Update Date | 02/11/2025
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Provider Practice Location Address
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Address Line | 2055 CRAIGSHIRE DR STE 215A
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City | SAINT LOUIS
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State | MO
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Zip | 63146-4036
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Country | US
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Telephone | 314-780-3689
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Fax |
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Provider Business Mailing Address
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Address Line | 2055 CRAIGSHIRE DR STE 215A
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City | SAINT LOUIS
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State | MO
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Zip | 63146-4036
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Country | US
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Telephone | 314-780-3689
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | SHERELLE N LITTLE
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Credential |
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Telephone | 314-701-2163
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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 |
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License Number State |
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