MEDICARE: BETHANY 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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1720938194
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BETHANY GRACE CARE LLC

Provider Business Mailing Address
First Line	:	93 CALDWELL PL
Second Line	:
City	:	SPRINGFIELD
State	:	NJ
Zip	:	07081-1731
Country	:	US
Telephone Number	:	862-233-5922
Fax Number	:

Provider Business Practice Location Address
First Line	:	93 CALDWELL PL
Second Line	:
City	:	SPRINGFIELD
State	:	NJ
Zip	:	07081-1731
Country	:	US
Telephone Number	:	862-233-5922
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. JONATHAN NDUKAKU IHEROBIEM
Credential	:
Telephone Number	:	862-233-5922

Provider Enumeration Date	:	02/03/2026
Last Update Date	:	02/03/2026

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Directions to “BETHANY GRACE CARE LLC ” Practice Location

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