=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790562940
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMFORT HANDS OF GRACE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/12/2023
-----------------------------------------------------
Last Update Date | 09/12/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2084 REDPINE DR
-----------------------------------------------------
City | SEMMES
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36575-7368
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 251-545-8133
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4005 MOFFETT RD
-----------------------------------------------------
City | MOBILE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36618-1213
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 251-545-8133
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | PORTIA MAYE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 251-545-8133
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------