Provider Demographics
NPI:1912788589
Name:MACGRACE STAFFING SERVICES LLC
Entity type:Organization
Organization Name:MACGRACE STAFFING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOD
Authorized Official - Prefix:
Authorized Official - First Name:HILDA
Authorized Official - Middle Name:NSUM
Authorized Official - Last Name:CHIATU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-742-8271
Mailing Address - Street 1:1741 MEADOWLAKE DR
Mailing Address - Street 2:
Mailing Address - City:TIFFIN
Mailing Address - State:OH
Mailing Address - Zip Code:44883-3235
Mailing Address - Country:US
Mailing Address - Phone:763-742-8271
Mailing Address - Fax:
Practice Address - Street 1:1741 MEADOWLAKE DR
Practice Address - Street 2:
Practice Address - City:TIFFIN
Practice Address - State:OH
Practice Address - Zip Code:44883-3235
Practice Address - Country:US
Practice Address - Phone:763-742-8271
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-10
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care