Provider Demographics
NPI:1891168746
Name:GRACE OF THE PINES HOME HEALTH LLC
Entity type:Organization
Organization Name:GRACE OF THE PINES HOME HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-745-4907
Mailing Address - Street 1:646 JENNINGS AVE
Mailing Address - Street 2:SUITE 18
Mailing Address - City:HOT SPRINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57747-1664
Mailing Address - Country:US
Mailing Address - Phone:605-745-4907
Mailing Address - Fax:605-745-4908
Practice Address - Street 1:646 JENNINGS AVE
Practice Address - Street 2:SUITE 18
Practice Address - City:HOT SPRINGS
Practice Address - State:SD
Practice Address - Zip Code:57747-1664
Practice Address - Country:US
Practice Address - Phone:605-745-4907
Practice Address - Fax:605-745-4908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-01
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health