| Organization Name: | SOUTHERN GRACE HEALTHCARE |
| NPI Number: | 1043609134 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | AUBREY KEKIWI (CEO) |
| Mailing Address: | 364 Racetrack Rd Mcdonough |
| State: | GA US |
| Postal Code: | 302521022 |
| Phone Number: | 6784328811 |
| Fax Number: | 6784328821 |
| NPI Enumeration Date: | 01/13/2015 |
| NPI Last Update Date: | 01/13/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 253Z00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Agencies |
| Taxonomy Classification: | In Home Supportive Care |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An In Home Supportive Care Agency provides services in the patient |