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General NPI Number Information
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NPI Number | 1720711575
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Entity Type | Organization
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Legal Business Name | CHARIS GRACE HEALTH CARE SERVICES INC.
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Dates
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Enumeration Date | 07/07/2022
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Last Update Date | 09/20/2024
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Provider Practice Location Address
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Address Line | 8280 WILLOW OAKS CORPORATE DR STE 600
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City | FAIRFAX
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State | VA
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Zip | 22031-4516
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Country | US
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Telephone | 571-575-4867
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Fax |
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Provider Business Mailing Address
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Address Line | 8280 WILLOW OAKS CORPORATE DR STE 600
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City | FAIRFAX
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State | VA
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Zip | 22031-4516
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Country | US
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Telephone | 703-589-9167
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Fax |
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Authorized Official
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Title or Position | ADMINISTATOR, DIRECTOR
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Name | HILDA KAETU-SMITH
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Credential |
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Telephone | 703-589-9167
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251F00000X
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Taxonomy Name | Home Infusion Agency
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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 | 251J00000X
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Taxonomy Name | Nursing Care Agency
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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 | 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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Taxonomy #4
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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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