Provider Demographics
NPI:1144930199
Name:GRACE HOME AND HEALTHCARE INC
Entity type:Organization
Organization Name:GRACE HOME AND HEALTHCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:AGATHA
Authorized Official - Middle Name:MANJOE
Authorized Official - Last Name:TUMBEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-210-8340
Mailing Address - Street 1:1001 LYNDE DR NE
Mailing Address - Street 2:
Mailing Address - City:FRIDLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55432-5740
Mailing Address - Country:US
Mailing Address - Phone:763-210-8340
Mailing Address - Fax:
Practice Address - Street 1:1001 LYNDE DR NE
Practice Address - Street 2:
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-5740
Practice Address - Country:US
Practice Address - Phone:763-210-8340
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-30
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness