Provider Demographics
NPI:1386259026
Name:GRACE ESSENTIAL CARE LLC
Entity type:Organization
Organization Name:GRACE ESSENTIAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRITTANY
Authorized Official - Middle Name:JENAE
Authorized Official - Last Name:WAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-683-7552
Mailing Address - Street 1:3246 PARKER RD
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63033-3733
Mailing Address - Country:US
Mailing Address - Phone:314-683-7552
Mailing Address - Fax:
Practice Address - Street 1:3236 PARKER RD
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63033-3733
Practice Address - Country:US
Practice Address - Phone:314-683-7552
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-10
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health