MEDICARE: GRACE HEALTHCARE SERVICES 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	:	1962283937
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRACE HEALTHCARE SERVICES LLC

Provider Business Mailing Address
First Line	:	6911 RICHMOND HWY # 324C
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22306-1842
Country	:	US
Telephone Number	:	240-491-6774
Fax Number	:

Provider Business Practice Location Address
First Line	:	6911 RICHMOND HWY # 324C
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22306-1842
Country	:	US
Telephone Number	:	240-491-6774
Fax Number	:

Authorized Official
Title or Position	:	PROGRAM DIRECTOR
Name	:	MR. KENNETH NGONG NGAM AYEAH
Credential	:	MPH
Telephone Number	:	240-491-6774

Provider Enumeration Date	:	10/06/2023
Last Update Date	:	10/06/2023

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