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General NPI Number Information
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NPI Number | 1710793229
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Entity Type | Organization
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Legal Business Name | WILLOW GRACE HOMECARE LLC
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Dates
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Enumeration Date | 12/09/2024
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Last Update Date | 12/09/2024
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Provider Practice Location Address
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Address Line | 1445 EAGLE VIEW BLVD #649
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City | ANTIOCH
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State | TN
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Zip | 37013
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Country | US
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Telephone | 615-522-5018
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Fax |
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Provider Business Mailing Address
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Address Line | 501 UNION ST STE 545
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City | NASHVILLE
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State | TN
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Zip | 37219-1876
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ADAUGO AGUZIE
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Credential |
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Telephone | 443-303-7120
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 385HR2055X
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Taxonomy Name | Child Mental Illness Respite Care
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 385HR2060X
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Taxonomy Name | Child Intellectual and/or Developmental Disabilities Respite Care
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 385HR2065X
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Taxonomy Name | Child Physical Disabilities Respite Care
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License Number |
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License Number State |
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Taxonomy #5
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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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