MEDICARE: GRACE HEALTHCARE, INC.

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	332B00000X	Durable Medical Equipment & Medical Supplies		MS
2	332BX2000X	Oxygen Equipment & Supplies (DME)

General Provider Information

NPI Number	:	1417065921
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRACE HEALTHCARE, INC.

Provider Business Mailing Address
First Line	:	555 E NORTH LN STE 5075
Second Line	:
City	:	CONSHOHOCKEN
State	:	PA
Zip	:	19428-2490
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6200 WASHINGTON AVE
Second Line	:
City	:	OCEAN SPRINGS
State	:	MS
Zip	:	39564-2653
Country	:	US
Telephone Number	:	228-226-9434
Fax Number	:	228-863-4314

Authorized Official
Title or Position	:	CCO
Name	:	WENDY RUSSALESI
Credential	:
Telephone Number	:	484-246-9499

Provider Enumeration Date	:	08/25/2006
Last Update Date	:	06/10/2026

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Directions to “GRACE HEALTHCARE, INC. ” Practice Location

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