Provider Demographics
NPI:1699072884
Name:GRACE PERSONAL CARE SERVICES, LLC
Entity type:Organization
Organization Name:GRACE PERSONAL CARE SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LANTONA
Authorized Official - Middle Name:T
Authorized Official - Last Name:THORNTON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:414-336-5556
Mailing Address - Street 1:PO BOX 06221
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53206-0221
Mailing Address - Country:US
Mailing Address - Phone:414-336-5556
Mailing Address - Fax:414-264-4825
Practice Address - Street 1:3246 N TEUTONIA AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53206-2265
Practice Address - Country:US
Practice Address - Phone:414-336-5556
Practice Address - Fax:414-264-4825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-24
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100011394Medicaid