Provider Demographics
NPI:1609694116
Name:GRACE HEALTHCARE LLC
Entity type:Organization
Organization Name:GRACE HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CYRIL
Authorized Official - Middle Name:G
Authorized Official - Last Name:BOLINJI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-284-4979
Mailing Address - Street 1:5007 BROOKLET WAY
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45042-3595
Mailing Address - Country:US
Mailing Address - Phone:585-284-4979
Mailing Address - Fax:
Practice Address - Street 1:5007 BROOKLET WAY
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45042-3595
Practice Address - Country:US
Practice Address - Phone:585-284-4979
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-02
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health