MEDICARE: REGINA GRATIAE FOUNDATION

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	251E00000X	Home Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396581146
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REGINA GRATIAE FOUNDATION

Provider Business Mailing Address
First Line	:	4450 SYRACUSE ST
Second Line	:
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48125-2121
Country	:	US
Telephone Number	:	313-686-9517
Fax Number	:

Provider Business Practice Location Address
First Line	:	4450 SYRACUSE ST
Second Line	:
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48125-2121
Country	:	US
Telephone Number	:	313-686-9517
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	GERALD C OKOLI
Credential	:
Telephone Number	:	313-686-9517

Provider Enumeration Date	:	07/02/2024
Last Update Date	:	07/02/2024

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Directions to “REGINA GRATIAE FOUNDATION ” Practice Location

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