Provider Demographics
NPI:1861742090
Name:GRACE AT HOME SENIOR CARE
Entity type:Organization
Organization Name:GRACE AT HOME SENIOR CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:MASTERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-835-4663
Mailing Address - Street 1:2902 E KIEHL AVE STE 1A
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:AR
Mailing Address - Zip Code:72120-3280
Mailing Address - Country:US
Mailing Address - Phone:501-835-4663
Mailing Address - Fax:
Practice Address - Street 1:2902 E KIEHL AVE STE 1A
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:AR
Practice Address - Zip Code:72120-3280
Practice Address - Country:US
Practice Address - Phone:501-835-4663
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-14
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health