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General NPI Number Information
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NPI Number | 1851744049
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Entity Type | Organization
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Legal Business Name | SWEET GRACE HOME HEALTH AGENCY, LLC
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Dates
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Enumeration Date | 07/22/2016
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Last Update Date | 07/22/2016
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Provider Practice Location Address
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Address Line | 112 W WASHINGTON ST SUITE 302
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City | SUFFOLK
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State | VA
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Zip | 23434-5246
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Country | US
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Telephone | 757-934-6000
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Fax | 757-934-6001
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Provider Business Mailing Address
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Address Line | 112 W WASHINGTON ST SUITE 302
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City | SUFFOLK
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State | VA
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Zip | 23434-5246
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Country | US
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Telephone | 757-934-6000
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Fax | 757-934-6001
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Authorized Official
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Title or Position | OWNER/ ADMINISTRATOR
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Name | MISS EVELYN MARIE BEAMON
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Credential |
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Telephone | 757-934-6000
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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 | HCO-171481
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License Number State | VA
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