Organization Name: | GRACE HEALTHCARE SERVICES, LLC |
NPI Number: | 1174669568 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | RENE L TROTTER (OFFICER) |
Mailing Address: | 104 E Market St Mc Leansboro |
State: | IL US |
Postal Code: | 628591317 |
Phone Number: | 6186433051 |
Fax Number: | 6186433164 |
NPI Enumeration Date: | 01/30/2007 |
NPI Last Update Date: | 04/20/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |