MEDICARE: GRACE HOME CARE AGENCY 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	:	1366959785
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRACE HOME CARE AGENCY LLC

Provider Business Mailing Address
First Line	:	1642 S PARKER RD STE 310A
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80231-2917
Country	:	US
Telephone Number	:	720-535-4301
Fax Number	:

Provider Business Practice Location Address
First Line	:	1642 S PARKER RD STE 310A
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80231-2917
Country	:	US
Telephone Number	:	720-535-4301
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	AGAVNIK APELYAN
Credential	:
Telephone Number	:	720-535-4301

Provider Enumeration Date	:	01/08/2018
Last Update Date	:	01/08/2018

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