MEDICARE: MIRIAM'S GRACE HOME HEALTH SERVICES, 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
2	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1205769767
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIRIAM'S GRACE HOME HEALTH SERVICES, LLC

Provider Business Mailing Address
First Line	:	6501 ARLINGTON EXPY
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32211-5779
Country	:	US
Telephone Number	:	305-389-5566
Fax Number	:

Provider Business Practice Location Address
First Line	:	6501 ARLINGTON EXPY
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32211-5779
Country	:	US
Telephone Number	:	305-389-5566
Fax Number	:

Authorized Official
Title or Position	:	CEO/OWNER
Name	:	MISS ANGELA LOMOTEY
Credential	:
Telephone Number	:	305-389-5566

Provider Enumeration Date	:	06/04/2026
Last Update Date	:	06/04/2026

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