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General NPI Number Information
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NPI Number | 1982150249
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Entity Type | Organization
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Legal Business Name | GRACE AVAIL AT HOME, LLC
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Dates
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Enumeration Date | 08/28/2016
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Last Update Date | 08/28/2016
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Provider Practice Location Address
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Address Line | 1337 E 8TH STREET
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City | ERIE
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State | PA
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Zip | 16503
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Country | US
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Telephone | 814-844-0195
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Fax |
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Provider Business Mailing Address
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Address Line | 1337 E 8TH ST
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City | ERIE
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State | PA
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Zip | 16503-1705
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Country | US
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Telephone | 814-844-0195
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SHAMIKA DAWN LIVINGSTON
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Credential | LPN
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Telephone | 814-844-0195
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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 | PN284419
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License Number State | PA
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