MEDICARE: GRACE HEALTH HOME 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	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1962275800
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRACE HEALTH HOME CARE LLC

Provider Business Mailing Address
First Line	:	5201 HEATHER WAY
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45424-8707
Country	:	US
Telephone Number	:	937-344-6916
Fax Number	:

Provider Business Practice Location Address
First Line	:	5201 HEATHER WAY
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45424-8707
Country	:	US
Telephone Number	:	937-344-6916
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	MR. DIEUDONNE H RUTURWA
Credential	:
Telephone Number	:	937-344-6916

Provider Enumeration Date	:	11/02/2023
Last Update Date	:	11/02/2023

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