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General NPI Number Information
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NPI Number | 1629493226
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Entity Type | Organization
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Legal Business Name | GRACE VISITATION SERVICES
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Dates
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Enumeration Date | 02/19/2014
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Last Update Date | 02/19/2014
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Provider Practice Location Address
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Address Line | 28350 LEWES GEORGETOWN HWY
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City | MILTON
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State | DE
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Zip | 19968-3115
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Country | US
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Telephone | 302-329-9475
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Fax |
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Provider Business Mailing Address
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Address Line | 28350 LEWES GEORGETOWN HWY
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City | MILTON
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State | DE
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Zip | 19968-3115
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Country | US
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Telephone | 302-329-9475
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | ANNALISE FORMAN
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Credential |
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Telephone | 302-329-9475
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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 | 2010605017
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License Number State | DE
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