MEDICARE: GRACE TO YOU 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	:	1952073538
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRACE TO YOU LLC

Provider Business Mailing Address
First Line	:	801 WABASH AVE
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28208-1542
Country	:	US
Telephone Number	:	980-465-4442
Fax Number	:

Provider Business Practice Location Address
First Line	:	801 WABASH AVE
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28208-1542
Country	:	US
Telephone Number	:	980-465-4442
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MONET MARTIN
Credential	:
Telephone Number	:	980-465-4442

Provider Enumeration Date	:	10/01/2021
Last Update Date	:	10/01/2021

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Directions to “GRACE TO YOU LLC ” Practice Location

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