MEDICARE: GRACE CARE 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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1548802457
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRACE CARE LLC

Provider Business Mailing Address
First Line	:	PO BOX 1570
Second Line	:
City	:	PRINCE FREDERICK
State	:	MD
Zip	:	20678-1570
Country	:	US
Telephone Number	:	410-586-3126
Fax Number	:	410-586-3128

Provider Business Practice Location Address
First Line	:	2311 WAYNE MEMORIAL DR
Second Line	:
City	:	GOLDSBORO
State	:	NC
Zip	:	27534-1725
Country	:	US
Telephone Number	:	410-586-3126
Fax Number	:	410-586-3128

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	TINA CLARKE
Credential	:
Telephone Number	:	410-586-3126

Provider Enumeration Date	:	10/11/2019
Last Update Date	:	10/11/2019

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