Provider Demographics
NPI:1962283937
Name:GRACE HEALTHCARE SERVICES LLC
Entity type:Organization
Organization Name:GRACE HEALTHCARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:NGONG
Authorized Official - Last Name:NGAM AYEAH
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:240-491-6774
Mailing Address - Street 1:6911 RICHMOND HWY # 324C
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22306-1842
Mailing Address - Country:US
Mailing Address - Phone:240-491-6774
Mailing Address - Fax:
Practice Address - Street 1:6911 RICHMOND HWY # 324C
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22306-1842
Practice Address - Country:US
Practice Address - Phone:240-491-6774
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-06
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care