Provider Demographics
NPI:1215626965
Name:GRACE AND MEMORY HOSPICE CARE LLC
Entity type:Organization
Organization Name:GRACE AND MEMORY HOSPICE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:COMFORT
Authorized Official - Middle Name:
Authorized Official - Last Name:AMIEKUMO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:763-843-5965
Mailing Address - Street 1:2305 S CUSTER RD 2002
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75072
Mailing Address - Country:US
Mailing Address - Phone:763-843-5965
Mailing Address - Fax:
Practice Address - Street 1:2305 S CUSTER RD 2002
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75072
Practice Address - Country:US
Practice Address - Phone:763-843-5965
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-08
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based