Provider Demographics
NPI:1548873383
Name:HAINES, GRACE ALICAY (CNA)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:ALICAY
Last Name:HAINES
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 HARVEST DR
Mailing Address - Street 2:
Mailing Address - City:ROMNEY
Mailing Address - State:WV
Mailing Address - Zip Code:26757-6350
Mailing Address - Country:US
Mailing Address - Phone:540-336-2501
Mailing Address - Fax:
Practice Address - Street 1:166 HARVEST DR
Practice Address - Street 2:
Practice Address - City:ROMNEY
Practice Address - State:WV
Practice Address - Zip Code:26757-6350
Practice Address - Country:US
Practice Address - Phone:540-336-2501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-30
Last Update Date:2020-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant