Provider Demographics
NPI:1649664772
Name:GRACE HOME CAREGIVERS, INC.
Entity type:Organization
Organization Name:GRACE HOME CAREGIVERS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KINGSLEY
Authorized Official - Middle Name:OSHO
Authorized Official - Last Name:OHIKU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:779-324-5802
Mailing Address - Street 1:20698 EAGLE BLUFF CT
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-3511
Mailing Address - Country:US
Mailing Address - Phone:779-324-5802
Mailing Address - Fax:815-534-5492
Practice Address - Street 1:20698 EAGLE BLUFF CT
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423
Practice Address - Country:US
Practice Address - Phone:779-324-5802
Practice Address - Fax:815-534-5492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-26
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3001158253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care