MEDICARE: GRACE HOME RESPIRATORY 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	004-00002711120-01	WI

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	:	1548249899
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRACE HOME RESPIRATORY INC

Provider Business Mailing Address
First Line	:	2204 N HILLCREST PKWY
Second Line	:	SUITE #2
City	:	ALTOONA
State	:	WI
Zip	:	54720-2626
Country	:	US
Telephone Number	:	715-832-7377
Fax Number	:	715-832-7031

Provider Business Practice Location Address
First Line	:	2204 N HILLCREST PKWY
Second Line	:	SUITE #2
City	:	ALTOONA
State	:	WI
Zip	:	54720-2626
Country	:	US
Telephone Number	:	715-832-7377
Fax Number	:	715-832-7031

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. CHARLES WILLIS RACLIFF
Credential	:	R.R.T.
Telephone Number	:	715-832-7377

Provider Enumeration Date	:	01/14/2006
Last Update Date	:	12/29/2016

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Directions to “GRACE HOME RESPIRATORY INC ” Practice Location

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