Provider Demographics
NPI:1972334985
Name:GRACE, MARIA D
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:D
Last Name:GRACE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 E SWEET ST # 291
Mailing Address - Street 2:
Mailing Address - City:ROYAL CENTER
Mailing Address - State:IN
Mailing Address - Zip Code:46978-9020
Mailing Address - Country:US
Mailing Address - Phone:574-398-9218
Mailing Address - Fax:
Practice Address - Street 1:204 E SWEET ST # 291
Practice Address - Street 2:
Practice Address - City:ROYAL CENTER
Practice Address - State:IN
Practice Address - Zip Code:46978-9020
Practice Address - Country:US
Practice Address - Phone:574-398-9218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-12
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care