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General NPI Number Information
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NPI Number | 1649664772
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Entity Type | Organization
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Legal Business Name | GRACE HOME CAREGIVERS, INC.
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Dates
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Enumeration Date | 03/26/2015
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Last Update Date | 03/26/2015
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Provider Practice Location Address
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Address Line | 20698 EAGLE BLUFF CT
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City | FRANKFORT
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State | IL
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Zip | 60423
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Country | US
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Telephone | 779-324-5802
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Fax | 815-534-5492
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Provider Business Mailing Address
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Address Line | 20698 EAGLE BLUFF CT
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City | FRANKFORT
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State | IL
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Zip | 60423-3511
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Country | US
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Telephone | 779-324-5802
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Fax | 815-534-5492
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. KINGSLEY OSHO OHIKU
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Credential |
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Telephone | 779-324-5802
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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 | 3001158
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License Number State | IL
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