MEDICARE: GRACE 1 HOME CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	253Z00000X	In Home Supportive Care Agency
2	343900000X	Non-emergency Medical Transport (VAN)
3	385H00000X	Respite Care
4	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1851139745
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRACE 1 HOME CARE LLC

Provider Business Mailing Address
First Line	:	16033 NE 9TH PL
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33162-4421
Country	:	US
Telephone Number	:	786-597-1168
Fax Number	:

Provider Business Practice Location Address
First Line	:	16033 NE 9TH PL
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33162-4421
Country	:	US
Telephone Number	:	786-597-1168
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ANTOINISE CHARLES
Credential	:
Telephone Number	:	786-597-1168

Provider Enumeration Date	:	07/16/2024
Last Update Date	:	07/16/2024

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