Provider Demographics
NPI:1306141734
Name:GRACE HOME HEALTH CARE SERVICE INC,
Entity type:Organization
Organization Name:GRACE HOME HEALTH CARE SERVICE INC,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:937-520-1087
Mailing Address - Street 1:38 FOUNTAIN AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45405-3702
Mailing Address - Country:US
Mailing Address - Phone:937-520-1087
Mailing Address - Fax:
Practice Address - Street 1:38 FOUNTAIN AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45405-3702
Practice Address - Country:US
Practice Address - Phone:937-520-1087
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-15
Last Update Date:2011-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X, 302F00000X, 253Z00000X
OH253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
No302F00000XManaged Care OrganizationsExclusive Provider Organization