MEDICARE: GIFTS OF GRACE 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	347C00000X	Private Vehicle
2	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1598368763
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GIFTS OF GRACE LLC

Provider Business Mailing Address
First Line	:	2692 MADISON RD STE N1-168
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45208-1321
Country	:	US
Telephone Number	:	513-227-6376
Fax Number	:	513-832-8149

Provider Business Practice Location Address
First Line	:	2692 MADISON RD STE N1-168
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45208-1321
Country	:	US
Telephone Number	:	513-227-6376
Fax Number	:	513-832-8149

Authorized Official
Title or Position	:	CEO
Name	:	MRS. JAMONDA WHITTLE
Credential	:	RN
Telephone Number	:	513-227-6376

Provider Enumeration Date	:	11/19/2020
Last Update Date	:	11/19/2020

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Directions to “GIFTS OF GRACE LLC ” Practice Location

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