Provider Demographics
NPI:1619837358
Name:GRACE AT HOME HEALTH CARE SERVICES LLC
Entity type:Organization
Organization Name:GRACE AT HOME HEALTH CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHAE
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-363-3527
Mailing Address - Street 1:3608 IMPERIAL GARDENS DR APT 6
Mailing Address - Street 2:
Mailing Address - City:SAINT ANN
Mailing Address - State:MO
Mailing Address - Zip Code:63074-2310
Mailing Address - Country:US
Mailing Address - Phone:314-363-3527
Mailing Address - Fax:314-582-2231
Practice Address - Street 1:2570 S BRENTWOOD BLVD
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:MO
Practice Address - Zip Code:63144-2309
Practice Address - Country:US
Practice Address - Phone:314-363-3527
Practice Address - Fax:314-582-2231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-11-14
Last Update Date:2025-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health