MEDICARE: ALL GOD'S GRACES, 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	251E00000X	Home Health Agency
2	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1487182564
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALL GOD'S GRACES, INC.

Provider Business Mailing Address
First Line	:	PO BOX 5184
Second Line	:
City	:	LIMA
State	:	OH
Zip	:	45802-5184
Country	:	US
Telephone Number	:	419-222-8109
Fax Number	:

Provider Business Practice Location Address
First Line	:	1142 W NORTH ST
Second Line	:
City	:	LIMA
State	:	OH
Zip	:	45805-2462
Country	:	US
Telephone Number	:	419-222-8109
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DANA KORTOKRAX
Credential	:
Telephone Number	:	419-222-8109

Provider Enumeration Date	:	06/01/2017
Last Update Date	:	06/01/2017

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Directions to “ALL GOD'S GRACES, INC. ” Practice Location

Language	Start Address	Practice Location

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