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General NPI Number Information
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NPI Number | 1578200267
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Entity Type | Organization
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Legal Business Name | GRACE HOME CARE LIVING
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Dates
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Enumeration Date | 05/16/2022
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Last Update Date | 05/25/2022
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Provider Practice Location Address
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Address Line | 110 STOCKTON ST
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City | STATESVILLE
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State | NC
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Zip | 28677-5253
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Country | US
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Telephone | 704-990-5886
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Fax |
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Provider Business Mailing Address
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Address Line | 110 STOCKTON ST
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City | STATESVILLE
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State | NC
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Zip | 28677-5253
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Country | US
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Telephone | 704-990-5886
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | PATRICIA W. SCOTT
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Credential | RN
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Telephone | 704-990-5886
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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