Provider Demographics
NPI:1104328541
Name:INSPIRED GRACE HEALTHCARE, INC
Entity type:Organization
Organization Name:INSPIRED GRACE HEALTHCARE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:IDOWU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:224-484-0596
Mailing Address - Street 1:1051 E MAIN ST STE 212
Mailing Address - Street 2:
Mailing Address - City:EAST DUNDEE
Mailing Address - State:IL
Mailing Address - Zip Code:60118-2455
Mailing Address - Country:US
Mailing Address - Phone:224-484-0596
Mailing Address - Fax:
Practice Address - Street 1:1051 E MAIN ST STE 212
Practice Address - Street 2:
Practice Address - City:EAST DUNDEE
Practice Address - State:IL
Practice Address - Zip Code:60118-2455
Practice Address - Country:US
Practice Address - Phone:224-484-0596
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INSPIRED GRACE HEALTHCARE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-03-01
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3001606253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care