MEDICARE: GRACE HOMES HEALTH SERVICES LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251C00000X	Developmentally Disabled Services Day Training Agency
2	385H00000X	Respite Care
3	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1245100460
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRACE HOMES HEALTH SERVICES LLC

Provider Business Mailing Address
First Line	:	PO BOX 441
Second Line	:
City	:	SYLVANIA
State	:	OH
Zip	:	43560-0441
Country	:	US
Telephone Number	:	513-602-2289
Fax Number	:

Provider Business Practice Location Address
First Line	:	5660 SOUTHWYCK BLVD # 220A
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43614-1566
Country	:	US
Telephone Number	:	513-602-2289
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JUDE BUSONG FONGUH
Credential	:	PHARMD
Telephone Number	:	513-602-2289

Provider Enumeration Date	:	11/11/2025
Last Update Date	:	11/11/2025

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