Provider Demographics
NPI:1972814127
Name:GRACE HEALTHCARE DME
Entity type:Organization
Organization Name:GRACE HEALTHCARE DME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:WOLF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:228-863-3331
Mailing Address - Street 1:1120 BROAD AVENUE
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39501
Mailing Address - Country:US
Mailing Address - Phone:228-863-3331
Mailing Address - Fax:228-863-3392
Practice Address - Street 1:300 HIGHWAY 11
Practice Address - Street 2:SUITE D
Practice Address - City:POPLARVILLE
Practice Address - State:MS
Practice Address - Zip Code:39470
Practice Address - Country:US
Practice Address - Phone:601-240-0001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-23
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies