MEDICARE: GRACE HOLISTIC SUPPORT HOME HEALTHCARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1104408434
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRACE HOLISTIC SUPPORT HOME HEALTHCARE LLC

Provider Business Mailing Address
First Line	:	137 N BISHOP AVE
Second Line	:
City	:	CLIFTON HEIGHTS
State	:	PA
Zip	:	19018-1305
Country	:	US
Telephone Number	:	484-466-6045
Fax Number	:

Provider Business Practice Location Address
First Line	:	137 N BISHOP AVE
Second Line	:
City	:	CLIFTON HEIGHTS
State	:	PA
Zip	:	19018-1305
Country	:	US
Telephone Number	:	484-466-6045
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	EUGENIA TURNER
Credential	:
Telephone Number	:	267-588-8699

Provider Enumeration Date	:	04/26/2021
Last Update Date	:	04/26/2021

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