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General NPI Number Information
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NPI Number | 1780107284
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Entity Type | Organization
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Legal Business Name | HIS GRACE HOME HEALTH CARE LLC
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Dates
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Enumeration Date | 07/18/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 2112 LAKE CAROLINA DR
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City | COLUMBIA
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State | SC
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Zip | 29229-7048
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Country | US
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Telephone | 301-768-7878
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Fax |
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Provider Business Mailing Address
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Address Line | 2112 LAKE CAROLINA DR
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City | COLUMBIA
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State | SC
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Zip | 29229-7048
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Country | US
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Telephone | 301-768-7878
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | OLUWASEUN BANKOLE
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Credential |
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Telephone | 301-768-7878
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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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Taxonomy #2
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Taxonomy Code | 372600000X
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Taxonomy Name | Adult Companion
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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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