MEDICARE: GRACE HOME HEALTH SERVICES, 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

General Provider Information

NPI Number	:	1659016814
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRACE HOME HEALTH SERVICES, INC.

Provider Business Mailing Address
First Line	:	3410 LA SIERRA AVE STE F-385
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92503-5270
Country	:	US
Telephone Number	:	951-465-6124
Fax Number	:

Provider Business Practice Location Address
First Line	:	3410 LA SIERRA AVE STE F-385
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92503-5270
Country	:	US
Telephone Number	:	323-702-0659
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. OGBOCHI MCKINNEY
Credential	:
Telephone Number	:	951-465-6124

Provider Enumeration Date	:	05/02/2022
Last Update Date	:	09/29/2022

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