Provider Demographics
NPI:1215488606
Name:GRACE HEALTH CARE
Entity type:Organization
Organization Name:GRACE HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:MISS
Authorized Official - First Name:ANAHITA
Authorized Official - Middle Name:
Authorized Official - Last Name:MESHKANI-MEHDIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MSN , FNP-C
Authorized Official - Phone:731-695-2165
Mailing Address - Street 1:100 CHERRYWOOD PL
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-1741
Mailing Address - Country:US
Mailing Address - Phone:731-668-1900
Mailing Address - Fax:731-664-2175
Practice Address - Street 1:100 CHERRYWOOD PL
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-1741
Practice Address - Country:US
Practice Address - Phone:731-668-1900
Practice Address - Fax:731-664-2175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-20
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000021900314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility